Jackson, Tony

Jackson, Tony is an individual health care provider with primary practice located at 300 E 15Th St , Merced CA 95341-6217. He recently has only one registered license in Nursing Service Providers / Licensed Psychiatric Technician, which is considered as his primary health care specialty. Jackson, Tony can be contacted via phone (209) 381-6879.

Contact Information

Primary practice address
300 E 15Th St Merced CA 95341-6217
Phone: (209) 381-6879
Fax: (209) 725-3775
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Licensed Psychiatric Technician 167G00000X 36316 California

Profile Details

NPI number 1225424211
LBN Legal business name Jackson, Tony
Credentials LPT
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 7th, 2015
Last updated Apr 7th, 2015 - about 9 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 1225424211 NPPES
California MEDICAID 1013030808

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