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Contact Information

ANISHA N JACKSON, PA
5 HUTTON CENTRE DR STE 950
SANTA ANA, CA92707-8744
 Phone: 855-434-7763
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Prevention Professional

405300000X
Indicates primary specialty

NPI Profile & details for ANISHA N JACKSON · (Female)

NPI # 1174760961
Status Active
Credentials PA (Physician Assistant)
Entity Individual
Enumeration date 01/15/2009
Last updated 10/04/2025 - About 8 months ago
Sole proprietor 1 No
Identifiers
  • CA License # 56906
  • CA Medicaid 1174760961
  • CA Other 56906 STATE CA LICENSE
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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