Jackson, Shamicka

Jackson, Shamicka is an individual health care provider with primary practice located at 2080 S E St , San Bernardino CA 92408-2773. She recently has only one registered license in Nursing Service Providers / Licensed Psychiatric Technician, which is considered as her primary health care specialty. Jackson, Shamicka can be contacted via phone (909) 388-9191.

Contact Information

Primary practice address
2080 S E St San Bernardino CA 92408-2773
Phone: (909) 388-9191
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Licensed Psychiatric Technician 167G00000X 37979 California

Profile Details

NPI number 1750764783
LBN Legal business name Jackson, Shamicka
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 8th, 2015
Last updated Jul 22nd, 2015 - about 11 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 1750764783 NPPES
California MEDICAID 1760651178

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