Individual
ANDREA IRENE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
921 E COMPTON BLVD, COMPTON, CA 90221-3303
(310) 668-6953
Mailing address
921 E COMPTON BLVD, COMPTON, CA 90221-3303
(310) 668-6953
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/28/2007
Last updated
08/04/2011
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