Individual
MS. CHARLRE-L E JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AA
Contact information
Practice address
1453 16TH ST, SANTA MONICA, CA 90404-2715
(310) 450-4050
(310) 450-7309
Mailing address
1453 16TH ST, SANTA MONICA, CA 90404-2715
(310) 450-4050
(310) 450-7309
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
197247
—
CA
Enumeration date
09/10/2008
Last updated
05/01/2017
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