MR. BRANDON JACKSON


Address: 1873 W 54th St, Los Angeles, CA 90062-2604
Phone: 5627947892

MR. BRANDON JACKSON (NPI# 1457994634) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1457994634
Entity Type Individual
Full Name MR. BRANDON JACKSON
Credential RECOVERY PRACTIONER
Practice Address 1873 W 54th St
Los Angeles
CA 90062-2604
Practice Telephone 5627947892
Practice Fax Number 3103493660
Mailing Telephone 5627947892
Mailing Fax Number 3103493660
Enumeration Date 2019-10-21
Last Update Date 2019-10-21
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 225400000X Rehabilitation Practitioner CA Respiratory, Developmental, Rehabilitative and Restorative Service Providers
N 175T00000X Peer Specialist Other Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
CA 1699246272 05

Other Providers BRANDON JACKSON

NPI Name Taxonomy Address Enumeration
1275046153 Brandon Lamarr Jackson Home Health Aide 400 Brunswick St, Mooresville, NC 28115-2246 2017-11-14
1083163521 Brandon Jackson Student in an Organized Health Care Education/Training Program 122 Lanier Dr, 322c, Statesboro, GA 30458-0804 2016-09-26
1881030310 Brandon Christopher Jackson Military Health Care Provider 6810 Camphor Ln, San Diego, CA 92139 2013-05-10
1861753949 Brandon Joshua Jackson Dentist 70 Virginia Ave, Staten Island, NY 10305-1748 2012-06-05
1952340671 Brandon Leroy Jackson Physical Therapist 4765 S. Durango Dr., Ste 106, Las Vegas, NV 89147 2006-06-06
1427611151 Brandon Clark Jackson Social Worker 42-77 65th Place, Woodside, NY 11377-5054 2019-04-18
1831658640 Brandon Thomas Jackson Plastic Surgery 251 E Huron St, Chicago, IL 60611-3055 2019-03-19
1164952644 Brandon Scott Jackson Behavior Technician 1200 W South Boulder Rd Ste 204, Lafayette, CO 80026-2833 2017-06-15
1578896031 Brandon T. Jackson Chiropractor 1258 Bryan Rd, O Fallon, MO 63366-3771 2009-09-15

Office Location

Street Address 1873 W 54TH ST
City LOS ANGELES
State CA
Zip Code 90062-2604

Providers in the same location

NPI Name Taxonomy Address Enumeration
1699246272 Create Realistic Change Inc Counselor 1873 W 54th St, Los Angeles, CA 90062-2604 2018-12-07
1013559897 Willie D Hobdy Rehabilitation Practitioner 1873 W 54th St, Los Angeles, CA 90062-2604 2019-10-12
1205478088 Roderick Vincent Todd Counselor 1873 W 54th St, Los Angeles, CA 90062-2604 2019-10-12
1487296265 Pamela Hoskins Rehabilitation Practitioner 1873 W 54th St, Los Angeles, CA 90062-2604 2019-10-12
1023650801 Henry N Hobdy Counselor 1873 W 54th St, Los Angeles, CA 90062-2604 2019-10-12

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1386298867 Prompt Healthcare, Inc., A Medical Corporation Family Medicine 1972 West 48th Street, #a, Los Angeles, CA 90062 2019-08-01
1083194773 Day One Detox Center, Inc Substance Abuse Rehabilitation Facility 1421 W 46th St, Los Angeles, CA 90062 2018-08-21
1457863706 The Dream Catcher Foundation, Inc. Residential Treatment Facility, Emotionally Disturbed Children 1537 W 49th St, Los Angeles, CA 90062 2017-10-26
1639680259 The Dream Catcher Foundation, Inc. Residential Treatment Facility, Emotionally Disturbed Children 1762 W 42nd St, Los Angeles, CA 90062 2017-10-23
1033535794 Trusana Monique Hall Licensed Vocational Nurse 4103 S. Halldale Ave, Los Angeles, CA 90062 2014-03-05
1093139644 Daniel Garcia Rehabilitation Practitioner 3381 Western Ave., Los Angeles, CA 90062 2014-02-18
1689003790 Crystal Vernon Case Manager/Care Coordinator 3881 S. Western Avenue, Los Angeles, CA 90062 2013-11-08
1184902934 Gerry Lynn Lockhart Case Manager/Care Coordinator 3881 S Western Avenue, Los Angeles, CA 90062 2011-07-28
1285921692 Atlantic Recovery Services Community/Behavioral Health 1701 Browning Street, Los Angeles, CA 90062 2011-07-06
1174796452 Tacora Leggett Counselor 5311 S Western Avenue, Los Angeles, CA 90062 2008-04-08
Find all providers in zip 90062

Taxonomy Information

Taxonomy Code 225400000X
Grouping Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Classification Rehabilitation Practitioner

Taxonomy Definition

A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1861013757 Terrisa Noel-rivera Luna Rehabilitation Practitioner 11303 Wilshire Blvd Bld 116, Los Angeles, CA 90025-5069 2020-05-01
1063046795 Leanne Margaret Cremin Rehabilitation Practitioner 2285 Westwood Blvd, Los Angeles, CA 90064-2017 2020-03-03
1720610421 Ronmoe Inc Rehabilitation Practitioner 2025 Westwood Blvd, Los Angeles, CA 90025-6328 2020-02-10
1104390723 Joana Rodriguez Rehabilitation Practitioner 3731 Stocker St., Suite 105, Los Angeles, CA 90008 2019-01-16
1376055145 Gentle F Carcamo Rehabilitation Practitioner 3731 Stoker Street, Ste. 105, Los Angeles, CA 90008 2017-11-01
1114445848 Claudia Melgar Rehabilitation Practitioner 1540 Alcazar St # St133, Los Angeles, CA 90089-0080 2017-09-01
1134646516 Maria Salas Rehabilitation Practitioner 333 S Beaudry Ave., Los Angeles, CA 90017 2017-08-25
1295257111 Freddy Pablo Rehabilitation Practitioner 3580 Wilshire Blvd., Ste. 800, Los Angeles, CA 90010 2017-07-12
1356893796 Rosemary Marroquin Rehabilitation Practitioner 511 N Harvard Blvd, Los Angeles, CA 90004-1906 2016-11-02
1902356520 Aida Kimberly Escobar Rehabilitation Practitioner 2715 E 5th St, Los Angeles, CA 90033-4422 2016-10-06
Find all providers in LOS ANGELES

Competitor

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City LOS ANGELES
Zip Code 90062

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Dataset Information

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.

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