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Contact Information

PORTIA M JACKSON, LVN
1022 SUNBROOK DR.
SAN BERNARDINO, CA92407
 Phone: 310-766-1838
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Licensed Vocational Nurse

164X00000X
Indicates primary specialty

NPI Profile & details for PORTIA M JACKSON · (Female)

NPI # 1619496049
Status Active
Credentials LVN (Licensed Vocational Nurse)
Entity Individual
Enumeration date 09/18/2017
Last updated 09/18/2017 - About 9 years ago
Sole proprietor 1 No
Identifiers
  • CA License # 272565
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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