Healthcare Provider Details

I. General information

NPI: 1306088646
Provider Name (Legal Business Name): DEE VALENCIA JACKSON RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEE VALENCIA JACKSON RNP

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 ADMIRALTY WAY
MARINA DEL REY CA
90292-5423
US

IV. Provider business mailing address

4500 TWEEDY BLVD
SOUTH GATE CA
90280-6334
US

V. Phone/Fax

Practice location:
  • Phone: 310-263-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number481901
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number13354
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: