Individual
ALLWYNE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2550 E FOOTHILL BLVD, PASADENA, CA 91107-3406
(626) 463-1021
Mailing address
2970 SANTA ANITA AVE, ALTADENA, CA 91001-1666
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
03/08/2010
Last updated
03/08/2010
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