Individual
DR. CODY RONALD JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3900 5TH AVE STE 110, SAN DIEGO, CA 92103-3122
(858) 554-1212
(858) 795-1195
Mailing address
9850 GENESEE AVE, STE 320, LA JOLLA, CA 92037-1208
(858) 554-1212
(858) 795-1195
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
A162265
CA
208D00000X
General Practice Physician
Primary
A162265
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/18/2009
Last updated
07/05/2022
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