Individual
BRIAN JEFFRY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2075 SAN JOAQUIN HILLS RD, NEWPORT BEACH, CA 92660-6505
(949) 760-9222
Mailing address
3801 MARQUETTE PL APT 4C, SAN DIEGO, CA 92106-1059
(541) 550-6572
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP95010531
CA
Other
Enumeration date
02/27/2019
Last updated
10/03/2019
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