Individual
ANTOINETTE D JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
222 E MAIN ST STE 117, BARSTOW, CA 92311-2365
(760) 255-1496
(760) 255-2542
Mailing address
222 E MAIN ST STE 117, BARSTOW, CA 92311-2365
(760) 255-1496
(760) 255-2542
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/06/2012
Last updated
11/20/2020
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