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General NPI Number Information
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NPI Number | 1003118878
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Entity Type | Individual
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Provider Name | TRISHA JACKSON
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Gender | Female
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 1201 W LA VETA AVE
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City | ORANGE
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State | CA
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Zip | 92868-4203
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Country | US
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Telephone | 714-509-8521
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Fax |
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Provider Business Mailing Address
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Address Line | 4740 WARNER AVE APT 101
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-3999
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Country | US
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Telephone | 702-378-6603
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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