Jackson, Robert Terrell

Jackson, Robert Terrell is an sole proprietor health care provider with primary practice located at 650 S Main St , Corona CA 92882-3417. He recently has only one registered license in Behavioral Health & Social Service Providers / Counselor, which is considered as his primary health care specialty. Jackson, Robert Terrell can be contacted via phone (951) 642-0341.

Contact Information

Primary practice address
650 S Main St Corona CA 92882-3417
Phone: (951) 642-0341
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X

Profile Details

NPI number 1851865034
LBN Legal business name Jackson, Robert Terrell
Credentials DIABETES LS COACH
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 21st, 2019
Last updated Jan 21st, 2019 - about 7 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 1851865034 NPPES
California Other 1558583427 RD,CDE IN THE PROCESS OF REAPPLYING FOR MEDICARE

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