Healthcare Provider Details

I. General information

NPI: 1811820194
Provider Name (Legal Business Name): LATESHIA MARIE JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 W AVENUE J2
LANCASTER CA
93536-6255
US

IV. Provider business mailing address

1601 CENTINELA AVE STE 5-A471
INGLEWOOD CA
90302-1076
US

V. Phone/Fax

Practice location:
  • Phone: 213-410-1991
  • Fax:
Mailing address:
  • Phone: 213-410-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: