Individual
TITUS CLINTON JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
444 S SAN VICENTE BLVD STE 603, LOS ANGELES, CA 90048-4178
(310) 423-4566
Mailing address
444 S SAN VICENTE BLVD STE 603, LOS ANGELES, CA 90048-4178
(310) 423-4566
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
99220
CA
Other
Enumeration date
06/08/2013
Last updated
03/01/2024
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