MEDICARE: DESTINY JACKSON

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1619649795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINY JACKSON

Provider Business Mailing Address
First Line	:	4200 JURUPA ST STE 308
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-1426
Country	:	US
Telephone Number	:	909-259-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 JURUPA ST STE 308
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-1426
Country	:	US
Telephone Number	:	909-259-5600
Fax Number	:

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

Provider Enumeration Date	:	09/28/2021
Last Update Date	:	09/28/2021

Similar Medicare Providers

1750229027 — NICHOLAS GUYETT
Practice Location Address:

4200 JURUPA ST STE 308
ONTARIO, CA
91761-1426

Practice Phone: 909-259-5600
Practice Fax:

1235258617 — DR. DARWIN BOWLES DC
Practice Location Address:

4200 JURUPA ST , SUITE 312
ONTARIO, CA
91761-1426

Practice Phone: 909-230-5515
Practice Fax: 909-230-5516

1780356535 — DONALD ANTHONY PRYOR
Practice Location Address:

4200 JURUPA ST STE 308
ONTARIO, CA
91761-1426

Practice Phone: 909-259-5600
Practice Fax:

1720730765 — JASON NGUYEN
Practice Location Address:

4200 JURUPA ST STE 308
ONTARIO, CA
91761-1426

Practice Phone: 909-259-5600
Practice Fax:

1619629516 — JESSICA MEDINA
Practice Location Address:

4200 JURUPA ST
ONTARIO, CA
91761-1426

Practice Phone: 909-756-8887
Practice Fax:

1073269882 — KARLA ISABEL NUNEZ
Practice Location Address:

4200 JURUPA ST STE 308
ONTARIO, CA
91761-1426

Practice Phone: 909-259-5600
Practice Fax:

Directions to “ DESTINY JACKSON ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.