Individual
NICKI ANGELYN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
5816 FREEBIRD LN UNIT 108, OAK PARK, CA 91377-5635
(310) 600-8163
Mailing address
5816 FREEBIRD LN UNIT 108, OAK PARK, CA 91377-5635
(310) 600-8163
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
29417
MT
Other
Enumeration date
10/07/2024
Last updated
10/07/2024
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