Provider Demographics
NPI:1366291551
Name:JONES JACKSON, ELIZABETH ALEXANDRIA
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ALEXANDRIA
Last Name:JONES JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8077 FLORENCE AVE # SUIE203A
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3826
Mailing Address - Country:US
Mailing Address - Phone:562-343-6749
Mailing Address - Fax:562-280-2813
Practice Address - Street 1:8077 FLORENCE AVE # SUIE203A
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3826
Practice Address - Country:US
Practice Address - Phone:562-343-6749
Practice Address - Fax:562-280-2813
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9740171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor