Doctor Name: | JENNA JACKSON |
NPI Number: | 1417334681 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | R.D. |
License Number: | 1071091 |
Business Practice Address: | 11165 Sepulveda Blvd Mission Hills, CA - 913451113 |
Business Phone Number: | 8668375779 |
Business Fax Number: | |
Mailing Address: | 4322 Matilija Ave, Apt 2 SHERMAN OAKS |
State: | CA |
Postal Code: | 914233624 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/27/2015 |
NPI Last Update Date: | 04/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | 1071091 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |