Individual
LENA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
730 MEDICAL CENTER CT, CHULA VISTA, CA 91911-6618
(619) 397-6901
Mailing address
1250 SANTA CORA AVE APT 721, CHULA VISTA, CA 91913-1556
(619) 410-0687
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
37981
CA
Other
Enumeration date
12/23/2015
Last updated
12/23/2015
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