Individual
JEMUEL E JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
760 MOUNTAIN VIEW ST, ALTADENA, CA 91001-4925
(626) 798-6793
Mailing address
760 MOUNTAIN VIEW ST, ALTADENA, CA 91001-4925
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN248946
CA
Other
Enumeration date
07/11/2013
Last updated
07/11/2013
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