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Search › California › 101YM0800X

Phoenix Jackson

NPI 1619349933 · on the registry since 2015 · sole proprietor

Practice

Address
1 Saint Vincents Dr
San Rafael, CA 94903
Phone
(415) 610-1768
Organisation at this address
St Vincents
Catholic Charities Cyo
Catholic Charities Cyo
Catholic Charities Cyo Of The Archdiocese Of San Francisco
Inferred from a shared address, not stated in the registry.
Clinicians at this address
99

Registry record

Primary taxonomy
101YM0800X
101YM0800X
Also registered as
106H00000X
101Y00000X
101YS0200X
390200000X
Licence states on file
CA
From the registry's licence fields, which are often incomplete.
Sex
Female
Record last updated
2016-10-25

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