Healthcare Provider Details

I. General information

NPI: 1346018959
Provider Name (Legal Business Name): CHRISTOPHER JACKSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3703 VOLK AVE
LONG BEACH CA
90808-2350
US

IV. Provider business mailing address

3703 VOLK AVE
LONG BEACH CA
90808-2350
US

V. Phone/Fax

Practice location:
  • Phone: 310-869-1156
  • Fax:
Mailing address:
  • Phone: 310-869-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number124000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: