Individual
DESHA OWANNA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CMA, LVN
Contact information
Practice address
1520 W 68TH ST, LOS ANGELES, CA 90047-2021
(323) 497-9583
Mailing address
309 E HILLCREST BLVD STE 519, INGLEWOOD, CA 90301-2405
(323) 531-4261
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
258755
CA
Other
Enumeration date
06/20/2011
Last updated
12/27/2015
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