Individual
DELORES JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
909 TINSLEY ST, E PALO ALTO, CA 94303-2584
(404) 444-3407
Mailing address
909 TINSLEY ST, E PALO ALTO, CA 94303-2584
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
CA
Enumeration date
03/30/2021
Last updated
03/30/2021
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