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Individual

CARRIE JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CA-CPT1

Contact information

Practice address
1370 VALLEY VISTA DR STE 200, DIAMOND BAR, CA 91765-3921
(840) 236-0671
Mailing address
1370 VALLEY VISTA DR STE 200, DIAMOND BAR, CA 91765-3921
(840) 236-0671

Taxonomy

Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
CPT00064512
CA

Other

Enumeration date
01/08/2024
Last updated
05/10/2024
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