Jackson, Bruce L

Jackson, Bruce L is an individual health care provider with primary practice located at 15863 Kasota Rd , Apple Valley CA 92307-4507. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Jackson, Bruce L can be contacted via phone (760) 948-1454.

Contact Information

Primary practice address
15863 Kasota Rd Apple Valley CA 92307-4507
Phone: (760) 948-1454
Fax: (760) 948-6100
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA14185 California

Profile Details

NPI number 1124072087
LBN Legal business name Jackson, Bruce L
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date May 22nd, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124072087 NPPES
California MEDICAID GR0050902

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