Organization
E C AMERICA
Active
Other names
Carol Jackson, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL JACKSON M.D. (DIRECTOR)
(949) 651-3415
Entity
Organization
Contact information
Practice address
361 HOSPITAL RD, SUITE 325, NEWPORT BEACH, CA 92663-3522
(949) 651-3415
Mailing address
1835 NEWPORT BLVD STE A109, #384, COSTA MESA, CA 92627-5007
(949) 651-3415
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
D3824
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G50085
MEDICARE PTAN
CA
Enumeration date
01/15/2009
Last updated
10/18/2012
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