Individual
TOMMY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1760 TERMINO AVE, 208, LONG BEACH, CA 90804-2105
(562) 961-5655
(562) 961-8836
Mailing address
1760 TERMINO AVE, 208, LONG BEACH, CA 90804-2105
(562) 961-5655
(562) 961-8836
Taxonomy
Speciality
Code
Description
License number
State
246ZX2200X
Orthopedic Assistant
Primary
02-0922
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02-0922
NATIONAL BOARD FOR CERTIFICATION OF ORTHOPAEDIC TECHNOLOGISTS
CA
Enumeration date
11/12/2016
Last updated
11/12/2016
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