JACK DOUGLAS LOCKHART (NPI# 1518481993) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518481993 |
| Entity Type | Individual |
| Full Name | JACK DOUGLAS LOCKHART |
| Practice Address |
10717 Camino Ruiz Ste 207 San Diego CA 92126-2364 |
| Practice Telephone | (858) 695-2211 |
| Practice Fax Number | 8586953521 |
| Mailing Telephone | 8586952211 |
| Mailing Fax Number | 8586953521 |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2017-07-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care | ||
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104822113 | Jack M Lockhart | Internal Medicine | 3111 Gundersen Dr, Onalaska, WI 54650-8447 | 2005-06-23 |
| Street Address |
10717 CAMINO RUIZ STE 207 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92126-2364 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326120916 | Tara Eileen Mcgrath | Marriage & Family Therapist | 10717 Camino Ruiz Ste 207, San Diego, CA 92126-2364 | 2006-10-20 |
| 1740887363 | Corinn Lippert | Student in an Organized Health Care Education/Training Program | 10717 Camino Ruiz Ste 207, San Diego, CA 92126-2364 | 2020-10-06 |
| 1023634623 | Kelsi S Harron | Student in an Organized Health Care Education/Training Program | 10717 Camino Ruiz Ste 207, San Diego, CA 92126-2364 | 2020-06-19 |
| 1962042390 | Kadirah Mubashshir | Marriage & Family Therapist | 10717 Camino Ruiz Ste 207, San Diego, CA 92126-2364 | 2020-01-14 |
| 1154961431 | Joan Mcfadden | Counselor | 10717 Camino Ruiz Ste 207, San Diego, CA 92126-2364 | 2020-01-14 |
| 1114566460 | Melissa Taylor | Social Worker | 10717 Camino Ruiz Ste 207, San Diego, CA 92126-2364 | 2020-01-04 |
| 1043856081 | Jadianna Hugle | Licensed Vocational Nurse | 10717 Camino Ruiz Ste 207, San Diego, CA 92126-2364 | 2019-11-25 |
| 1427699545 | Beverly Sharifian | Counselor | 10717 Camino Ruiz Ste 207, San Diego, CA 92126-2364 | 2019-09-30 |
| 1700430196 | Jessica Carrie Imhoff | Counselor | 10717 Camino Ruiz Ste 207, San Diego, CA 92126 | 2019-07-24 |
| 1629538061 | Zhao Jia | Student in an Organized Health Care Education/Training Program | 10717 Camino Ruiz Ste 207, San Diego, CA 92126-2364 | 2019-03-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730741299 | Eye Connection Optometry, Inc | Optometrist | 9516 Miramar Road, San Diego, CA 92126 | 2019-07-05 |
| 1811450935 | Anne Phabmixay | Student in an Organized Health Care Education/Training Program | Douglas Young Wellness Center, 10717 Camino Ruiz Suite 207, San Diego, CA 92126 | 2019-04-08 |
| 1679035588 | Emily Nguyen | Registered Nurse | 8210 Elston Place, San Diego, CA 92126 | 2019-04-01 |
| 1558832139 | Dana Douglas-hiley | Speech-Language Pathologist | 9606 Tierra Grande St., Suite 107, San Diego, CA 92126 | 2018-12-08 |
| 1275022873 | Breeann Nicole Poulson | Speech-Language Pathologist | 9466 Black Mountain Rd Suite 100, San Diego, CA 92126 | 2018-05-09 |
| 1659878882 | My Phuong Thi Phan | Registered Nurse | 10938 Hyades Way, San Diego, CA 92126 | 2018-04-13 |
| 1083132153 | Ruth Tamar Morales | Occupational Therapist | Children's Ot Services, Inc, 9606 Tierra Grande St., #104, San Diego, CA 92126 | 2017-09-08 |
| 1487184339 | Chelsea Irene Johnson | Marriage & Family Therapist | 8670 New Salem St. Unit 106, San Diego, CA 92126 | 2017-06-14 |
| 1336508506 | Brenda L. Bebal | Nurse Practitioner | 10737 Camino Ruiz; Ste 235, Operation Samahan Health Clinic, San Diego, CA 92126 | 2016-02-17 |
| 1700245099 | Naval Medical Center San Diego | Pharmacy | Mcas Miramar Exchange Pharmacy, Bldg 2660, San Diego, CA 92126 | 2016-02-16 |
| Find all providers in zip 92126 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043826753 | Dayjahnay Shantay Davenport | Peer Specialist | 3347 Lincoln Ave, San Diego, CA 92104-2111 | 2020-09-17 |
| 1427683101 | Gerardo Castro | Peer Specialist | 5555 Reservoir Dr # 204-a, San Diego, CA 92120-5134 | 2020-03-03 |
| 1487298840 | Garrett Ives | Peer Specialist | 2909 Keats St Apt 7, San Diego, CA 92106-2345 | 2019-10-29 |
| 1144882622 | Melissa Ratsamy | Peer Specialist | 286 Euclid Ave Project Enable, #102, San Diego, CA 92114 | 2019-07-03 |
| 1699258459 | Talya Donahue | Peer Specialist | 1045 Ninth Ave, San Diego, CA 92101 | 2018-09-07 |
| 1811434467 | Deborah Sue Lynn | Peer Specialist | 140 W. Arbor Dr., Ucsd Gifford Outpatient Clinic, San Diego, CA 92103-2421 | 2017-01-20 |
| 1023463163 | Miguel Pablo Surposa | Peer Specialist | 5711 Bolivar St, San Diego, CA 92139-1617 | 2016-04-26 |
| 1376140590 | Leon Samuel Mancilla | Peer Specialist | 5555 Reservoir Dr, San Diego, CA 92120-5134 | 2020-10-01 |
| 1982210092 | Nicole Lynn Iwan | Peer Specialist | 3491 Kurtz St Ste 150, San Diego, CA 92110-4430 | 2020-09-23 |
| 1962014001 | Paulina Alvarado | Peer Specialist | 6160 Mission Gorge Rd, San Diego, CA 92120-3410 | 2020-08-19 |
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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.