MEDICARE: JACKSON MA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A81950	CA

General Provider Information

NPI Number	:	1447298732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKSON MA M.D.

Provider Business Mailing Address
First Line	:	120 W BEVERLY BLVD
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-4305
Country	:	US
Telephone Number	:	323-528-1565
Fax Number	:	323-725-1869

Provider Business Practice Location Address
First Line	:	120 W BEVERLY BLVD
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-4305
Country	:	US
Telephone Number	:	323-528-1565
Fax Number	:	323-271-4068

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	03/30/2026

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