MICHAEL DEANGELO JACKSON

SAN DIEGO, CA
NPI1821879958
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: CA  95027684)
Enumeration Date2023-10-13
Last Update Date2023-10-13
Business Address
MICHAEL DEANGELO JACKSON Nurse Practitioner
200 W ARBOR DR
SAN DIEGO, CA 92103-9000
Phone number: 619-543-2154
Mailing Address
MICHAEL DEANGELO JACKSON Nurse Practitioner
1555 HIKERS TRAIL DR
CHULA VISTA, CA 91915-1826
Phone number: 619-852-6152
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