Individual
ELL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
561 SHOTWELL ST APT B, SAN FRANCISCO, CA 94110-1951
(415) 252-1853
(415) 252-1851
Mailing address
561 SHOTWELL ST APT B, SAN FRANCISCO, CA 94110-1951
(415) 252-1853
(415) 252-1851
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
12/13/2016
Last updated
12/13/2016
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