Individual
MARTHA Y BRANTLEY-JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
25400 ALESSANDRO BLVD STE 101, MORENO VALLEY, CA 92553-4319
(951) 570-0043
Mailing address
25400 ALESSANDRO BLVD STE 101, MORENO VALLEY, CA 92553-4319
(951) 570-0043
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
CA
Other
Enumeration date
05/24/2019
Last updated
05/24/2019
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