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NPI Code Detail

MEDICARE: ROBERT J JACKSON M.D., INC.

MEDICARE: ROBERT J JACKSON M.D., INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207T00000XNeurological Surgery PhysicianA71112CA

General Provider Information

NPI Number : 1538190830
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERT J JACKSON M.D., INC.
Provider Business Mailing Address
First Line : 23961 CALLE DE LA MAGDALENA STE 405
Second Line :
City : LAGUNA HILLS
State : CA
Zip : 92653-3683
Country : US
Telephone Number : 949-588-5800
Fax Number : 949-380-3344
Provider Business Practice Location Address
First Line : 23961 CALLE DE LA MAGDALENA STE 405
Second Line :
City : LAGUNA HILLS
State : CA
Zip : 92653-3683
Country : US
Telephone Number : 949-588-5800
Fax Number : 949-380-3344
Authorized Official
Title or Position : OWNER
Name : DR. ROBERT J JACKSON
Credential : M.D.
Telephone Number : 949-588-5800
Provider Enumeration Date : 07/05/2006
Last Update Date : 10/02/2024

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