Individual
MR. DARVALE LAVON JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3695 HIGH ST, OAKLAND, CA 94619-2105
(510) 434-7990
(510) 434-7991
Mailing address
1429 WOODSIDE DR, MODESTO, CA 95355-1724
(408) 832-5185
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
CA
Other
Enumeration date
03/26/2007
Last updated
11/09/2023
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