DR. MICHELLE JACKSON (NPI# 1184846529) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184846529 |
| Entity Type | Individual |
| Full Name | DR. MICHELLE JACKSON |
| Credential | MD |
| Practice Address |
3613 Vista Way Oceanside CA 92056-4522 |
| Practice Telephone | 7607585340 |
| Practice Fax Number | 7607585502 |
| Mailing Telephone | 7607585340 |
| Mailing Fax Number | 7607585502 |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2012-08-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ND0900X |
Dermatology Specialization: Dermatopathology |
A102012 | CA | Allopathic & Osteopathic Physicians |
| Y | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
A102012 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | PTAN | GG162Z | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104434067 | Michelle Jackson | Behavior Technician | 6961 Rooks Ct Apt 305, Frederick, MD 21703-2781 | 2020-07-16 |
| 1790347722 | Michelle Lynn Jackson | Family Medicine | 456 Circle Dr, Kewanee, IL 61443-3622 | 2019-06-29 |
| 1396301487 | Michelle Jackson | Technician | 14000 Castle Blvd Apt 703, Silver Spring, MD 20904-4640 | 2019-05-14 |
| 1184196685 | Michelle Maria Jackson | Health Educator | 220 E 89th St, Brooklyn, NY 11236-1418 | 2018-12-20 |
| 1396253258 | Michelle Laray Jackson | Counselor | 3765 Carisbrook Dr, North Las Vegas, NV 89081-6631 | 2018-01-12 |
| 1427509173 | Michelle Jackson | Behavioral Analyst | 115 Franklin St Ne Apt H21, Washington, DC 20002-1091 | 2016-10-18 |
| 1891193678 | Michelle Jackson | Occupational Therapy Assistant | 12611 Hickman Pl, Denver, CO 80239-6204 | 2014-12-10 |
| 1215338330 | Michelle Jackson | Nurse Practitioner | 115 Fields St # De, Mooresville, IN 46158-1492 | 2014-09-08 |
| 1699058008 | Michelle A Jackson | Occupational Therapist | 6045 Ashford Ln, Unit 102, Naples, FL 34110-2416 | 2011-09-21 |
| 1285923185 | Michelle Ann Jackson | Rehabilitation Practitioner | 7124 Diving Petrels Pl, 7124 Diving Petrels Pl, North Las Vegas, NV 89084-2353 | 2011-03-31 |
| Street Address |
3613 VISTA WAY |
| City | OCEANSIDE |
| State | CA |
| Zip Code | 92056-4522 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538191077 | Dermatologist Medical Group of North County, Inc | Dermatology | 3613 Vista Way, Oceanside, CA 92056-4522 | 2006-07-07 |
| 1710374889 | Alina Goldenberg | Dermatology | 3613 Vista Way, Oceanside, CA 92056 | 2015-04-16 |
| 1801155775 | Amanda Mcconnell | Physician Assistant | 3613 Vista Way, Oceanside, CA 92056-4522 | 2012-05-11 |
| 1912266883 | Mitzi Bray | Physician Assistant | 3613 Vista Way, Oceanside, CA 92056-4522 | 2012-05-11 |
| 1396060513 | Nicole Mau | Dermatology | 3613 Vista Way, Oceanside, CA 92056-4522 | 2010-03-30 |
| 1689817983 | Sheila Meena Krishna | Dermatology | 3613 Vista Way, Oceanside, CA 92056-4522 | 2009-04-16 |
| 1154355097 | Sherry Lynn Rotunda | Dermatology | 3613 Vista Way, Oceanside, CA 92056 | 2006-07-10 |
| 1952333254 | Steven Mark Leshaw | Dermatology | 3613 Vista Way, Oceanside, CA 92056-4522 | 2006-07-07 |
| 1144252388 | Robert Scheinberg | Dermatology | 3613 Vista Way, Oceanside, CA 92056 | 2006-07-07 |
| 1235161308 | Alice Y Liu | Dermatology | 3613 Vista Way, Oceanside, CA 92056-4522 | 2006-07-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174148639 | Universal Health Net San Diego | Hospice Care, Community Based | 4155 Oceanside Blvd, Suite 240, Oceanside, CA 92056 | 2020-06-10 |
| 1750913216 | Jared Pomerenke | Counselor | 3923 Warning Rd., Suite D, Oceanside, CA 92056 | 2020-02-12 |
| 1700424728 | Donna Jean Trapolino | Dental Hygienist | Bldg414006 Nelson Rd, Camp Pendleton, CA 92056 | 2019-12-20 |
| 1679122717 | David King Ping | Registered Nurse | 3609 Ocean Ranch Blvd Street 104, Oceanside, CA 92056 | 2019-09-11 |
| 1396254058 | Alison Schurman | Nurse Practitioner | 200 Mercy Circle Dr, Department of Pediatrics, Oceanside, CA 92056 | 2017-09-26 |
| 1407212665 | Yolanda Orozco Gaeta | Marriage & Family Therapist | 3923 Waring Road Ste D, North Coastal Treatment Recovery Center, Oceanside, CA 92056 | 2016-01-04 |
| 1871982751 | Wael Wassef | Pharmacist | 4755 Oceanside Blvd Ste 130, Oceanside, CA 92056 | 2015-01-15 |
| 1639501869 | William Stacy Parks | Family Medicine | 2376 Back Nine St., Oceanside, CA 92056 | 2013-07-30 |
| 1760725766 | Great Expectations Services Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4825 Glenhaven Drive, Oceanside, CA 92056 | 2013-03-28 |
| 1649533993 | Justin Bowles | Family Medicine | 1761 Avenida Segovia, Oceanside, CA 92056 | 2012-06-21 |
| Find all providers in zip 92056 | ||||
| Taxonomy Code | 207NS0135X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | Procedural Dermatology |
| Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers). |
| Notes: Source: American Board of Dermatology, 2007, www.abderm.org [1/1/2008: definition added, source added, title changed] Additional Resources: Some ABMS board certified dermatologists have completed a one-year ACGME approved fellowship in Procedural Dermatology, which has been offered since 2003. At this time the ABD does not offer subspecialty certification in Procedural Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477878817 | Jerrell Borup | Dermatology | 4439 Old River St, Oceanside, CA 92057-6004 | 2010-03-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578175006 | Lms Medical Services | Dermatology | 1118 N Mccadden Pl, Los Angeles, CA 90038-1213 | 2020-08-17 |
| 1932687241 | Silhouette Medical Group | Dermatology | 101 E Vineyard Ave Ste 107, Livermore, CA 94550-6877 | 2018-07-31 |
| 1780188482 | California Dermatology Physicians | Dermatology | 1902 Fullerton Ave # 102, Corona, CA 92881-3112 | 2018-03-19 |
| 1942709738 | Azadeh Shirazi Md Inc | Dermatology | 7301 Girard Ave Ste 202, La Jolla, CA 92037-5151 | 2018-02-07 |
| 1205342920 | Solano Dermatology Associates Inc | Dermatology | 1700 2nd St Ste 220, Napa, CA 94559-2455 | 2017-12-18 |
| 1831603901 | Laser Medspa, Inc. | Dermatology | 73655 El Paseo Ste N, Palm Desert, CA 92260-4304 | 2017-11-27 |
| 1326427204 | Jennifer Herrmann Md Inc | Dermatology | 421 N Rodeo Dr Ste 7, Beverly Hills, CA 90210-4514 | 2015-05-25 |
| 1235540196 | Microsurgery Goup | Dermatology | 21039 S Figueroa Ave Suite 201, Carson, CA 90745-7042 | 2014-05-14 |
| 1811261183 | Robert Ray Nettles | Dermatology | 8500 Wilshire Blvd Ste 630, Beverly Hills, CA 90211-3139 | 2012-03-02 |
| 1164748737 | Jane Chung | Dermatology | 895 E Fremont Ave Ste 201, Sunnyvale, CA 94087-2973 | 2010-04-08 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.