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NPI Code Detail

MEDICARE: MRS. TINA E JACKSON RAS

MEDICARE: MRS. TINA E JACKSON RAS
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
1101YA0400XAddiction (Substance Use Disorder) CounselorC034980715CA

General Provider Information

NPI Number : 1881809291
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TINA E JACKSON RAS
Provider Business Mailing Address
First Line : 749 CALICO WAY
Second Line :
City : OAKLEY
State : CA
Zip : 94561-3017
Country : US
Telephone Number : 925-679-3296
Fax Number :
Provider Business Practice Location Address
First Line : 1001 GRAND AVE
Second Line :
City : SACRAMENTO
State : CA
Zip : 95838-3512
Country : US
Telephone Number : 916-929-6103
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2007
Last Update Date : 10/26/2021

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