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Individual

MICHAEL DEANGELO JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
NURSE PRACTITIONER

Contact information

Practice address
333 W BROADWAY STE 310, LONG BEACH, CA 90802-4438
(562) 491-6465
Mailing address
3835 N FREEWAY BLVD STE 100, SACRAMENTO, CA 95834-1954

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95027684
CA

Other

Enumeration date
10/13/2023
Last updated
04/13/2026
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