Individual
CHRISTIAN DEANTHONY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CTRS
Contact information
Practice address
330 GOLDEN SHR STE 250, LONG BEACH, CA 90802-4270
(562) 247-0713
(800) 985-5002
Mailing address
818 W 106TH ST, LOS ANGELES, CA 90044-4438
(323) 867-3923
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
83338
CA
Other
Enumeration date
12/16/2020
Last updated
12/16/2020
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