Search › Texas › 106H00000X
Illya Jackson
NPI 1700269149 · on the registry since 2015 · sole proprietor
Practice
- Address
- 1518 Vaughn Blvd
Ft Worth, TX 76105 - Phone
- (214) 515-2079
Registry record
- Primary taxonomy
- 106H00000X
106H00000X
- Licence states on file
- CA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2015-07-02
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 Texas