Individual
DWAINE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 E KAY ST, COMPTON, CA 90221-1752
(310) 898-2450
Mailing address
1500 E KAY ST, COMPTON, CA 90221-1752
(310) 898-2450
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
06/09/2014
Last updated
06/09/2014
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