| NPI | 1841091220 |
|---|---|
| Former Legal Business Name | JACKSON MEDICAL OFFICE LLC |
| Entity Type | Organization |
| Authorized Contact | JORGE P AMAYA CEO 728-205-7604 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2025-03-21 |
| Last Update Date | 2025-03-22 |