| NPI | 1154627362 |
|---|---|
| Former Name | AMAIYA MELISSA JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA58134) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CA 58134) |
| Enumeration Date | 2011-02-04 |
| Last Update Date | 2025-08-15 |