Glenn, Tara Jackson

Glenn, Tara Jackson is an individual health care provider with primary practice located at 9300 Campus Point Dr , La Jolla CA 92037-1300. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine. Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine is her primary health care specialty. Glenn, Tara Jackson can be contacted via phone (858) 249-5800.

Contact Information

Primary practice address
9300 Campus Point Dr La Jolla CA 92037-1300
Phone: (858) 249-5800
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X A170207 California
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 35-126046 Ohio
Allopathic & Osteopathic Physicians / Neonatal-Perinatal Medicine 2080N0001X A170207 California

Profile Details

NPI number 1992060974
LBN Legal business name Glenn, Tara Jackson
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 6th, 2012
Last updated Apr 8th, 2021 - about 3 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 1992060974 NPPES
Ohio MEDICAID 0148250

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