Healthcare Provider Details

I. General information

NPI: 1235352220
Provider Name (Legal Business Name): RHONETTE ESTELLE JACKSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N SUNRISE AVE STE 1309
ROSEVILLE CA
95661-2933
US

IV. Provider business mailing address

777 12TH ST STE 250
SACRAMENTO CA
95814-1929
US

V. Phone/Fax

Practice location:
  • Phone: 916-737-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG080369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: