Healthcare Provider Details

I. General information

NPI: 1033238928
Provider Name (Legal Business Name): MS. VICTORIA LYNN JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 W AVENUE J
LANCASTER CA
93534-3443
US

IV. Provider business mailing address

921 W AVENUE J STE C
LANCASTER CA
93534-3443
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-0131
  • Fax: 661-729-8912
Mailing address:
  • Phone: 661-949-0131
  • Fax: 661-729-8912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: