Individual
DR. RICHARD JOSEPH JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
650 CHARLES E YOUNG DR S, EHS SPH UCLA BOX 56-070, LOS ANGELES, CA 90095-1772
(310) 206-8522
(310) 794-2106
Mailing address
650 CHARLES E YOUNG DR S, EHS SPH UCLA BOX 56-070, LOS ANGELES, CA 90095-1772
(310) 206-8522
(310) 794-2106
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
G34076
CA
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
G34076
CA
Other
Enumeration date
12/14/2009
Last updated
12/14/2009
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