Individual
JILL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1111 W 6TH ST, SUITE # 111, LOS ANGELES, CA 90017-1800
(213) 482-6400
(213) 482-6408
Mailing address
600 ST PAUL AVE, STE 100, LOS ANGELES, CA 90017-2038
(213) 482-6400
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265520183
—
CA
05
—
1306922554
—
CA
05
—
1841342318
—
CA
Enumeration date
02/23/2007
Last updated
07/27/2012
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