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Brandon Jackson, RECOVERY PRACTIONER
NPI 1457994634 · on the registry since 2019
Practice
- Address
- 1873 W 54th St
Los Angeles, CA 90062 - Phone
- (562) 794-7892
- Fax
- (310) 349-3660
- Organisation at this address
- Create Realistic Change Inc
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 4
Registry record
- Primary taxonomy
- 225400000X
225400000X
- Also registered as
- 175T00000X
- Licence states on file
- CA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2019-10-21
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California