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General NPI Number Information
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NPI Number | 1639264864
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Entity Type | Individual
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Provider Name | CHRISTIAN STERLING JACKSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | LOMA LINDA VA MEDICAL CENTER 11201 BENTON STREET 3A-58/111G
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City | LOMA LINDA
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State | CA
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Zip | 92354
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Country | US
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Telephone | 909-825-7084
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Fax | 909-777-3260
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Provider Business Mailing Address
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Address Line | LOMA LINDA VA MEDICAL CENTER 11201 BENTON STREET 3A-58/111G
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City | LOMA LINDA
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State | CA
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Zip | 92354
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Country | US
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Telephone | 909-825-7084
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Fax | 909-777-3260
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A101156
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License Number State | CA
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