DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: MR. GLENN JACKSON JR.

MEDICARE: MR. GLENN JACKSON JR.
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1831720093
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GLENN JACKSON JR.
Provider Business Mailing Address
First Line : 119 W TORRANCE BLVD STE 100
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90277-3600
Country : US
Telephone Number : 310-374-3300
Fax Number : 310-374-3307
Provider Business Practice Location Address
First Line : 6767 FOREST LAWN DR STE 100
Second Line :
City : LOS ANGELES
State : CA
Zip : 90068-1027
Country : US
Telephone Number : 310-374-3300
Fax Number : 310-374-3307
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2020
Last Update Date : 04/21/2026

Similar Medicare Providers

1568399426 — HAZEL TAGHIZADEH
Practice Location Address:
6767 FOREST LAWN DR STE 100
LOS ANGELES, CA
90068-1027
Practice Phone: 310-374-3300
Practice Fax:
1487509006 — ANDREW CARTER
Practice Location Address:
6767 FOREST LAWN DR
LOS ANGELES, CA
90068-1027
Practice Phone: 310-747-4235
Practice Fax:
1295680817 — ASHLEY SOLEDAD GARCIA
Practice Location Address:
6767 FOREST LAWN DR
LOS ANGELES, CA
90068-1027
Practice Phone: 310-747-4235
Practice Fax:
1104771724 — YETUNDE OGUNLEYE
Practice Location Address:
6767 FOREST LAWN DR
LOS ANGELES, CA
90068-1027
Practice Phone: 310-747-4235
Practice Fax:
1093660615 — JOSHUA RADOC DULLANO
Practice Location Address:
6767 FOREST LAWN DR
LOS ANGELES, CA
90068-1027
Practice Phone: 310-747-4235
Practice Fax:
1073452553 — BRANDI-LYNN PETIT
Practice Location Address:
6767 FOREST LAWN DR
LOS ANGELES, CA
90068-1027
Practice Phone: 310-747-4237
Practice Fax:

Directions to “ MR. GLENN JACKSON JR. ” 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.