Healthcare Provider Details

I. General information

NPI: 1225651367
Provider Name (Legal Business Name): LAURINDA JACKSON MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2020
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 475 BOX 1
FPO AP
96350-1200
US

IV. Provider business mailing address

NAVAL MEDICAL CENTER SAN DIEGO 38400 BOB WILSON DR
SAN DIEGO CA
92134-5000
US

V. Phone/Fax

Practice location:
  • Phone: 831-325-5057
  • Fax:
Mailing address:
  • Phone: 831-325-5057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101278377
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: