Individual
MR. BRUCE L JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
15863 KASOTA RD, APPLE VALLEY, CA 92307-4507
(760) 948-1454
(760) 948-6100
Mailing address
11919 HESPERIA RD, HESPERIA, CA 92345-1855
(760) 948-1454
(760) 948-6100
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA14185
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0050902
—
CA
Enumeration date
05/22/2006
Last updated
07/08/2007
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