05D0580056 CLIA NUMBER - CHARLES JACKSON MD

Laboratory Demographics

CLIA Number: 05D0580056

Facility Name: CHARLES JACKSON MD

Facility Address:
17122 BEACH BLVD, SUITE 102
HUNTINGTON BEACH, CA
ZIP 92647
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Facility Phone Number: (714) 847-6545

Facility Type: PHYSICIAN OFFICE

Certificate Type: Microscopy

NPI Number: 1083662845

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	05D0580056
LAB Type	PHYSICIAN OFFICE
Facility Name	CHARLES JACKSON MD
Street	17122 BEACH BLVD, SUITE 102
City	HUNTINGTON BEACH
State	CA
ZIP	92647
Phone	(714) 847-6545

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This page was last updated on: 5/11/2023