Individual
DR. JACKSON VANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3020 CHILDRENS WAY, SAN DIEGO, CA 92123-4223
(858) 966-8036
Mailing address
3020 CHILDRENS WAY, MC5075, SAN DIEGO, CA 92123-4223
(858) 966-8036
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
A120394
CA
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
RS2014-0568
NM
Other
Enumeration date
02/16/2011
Last updated
12/15/2016
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