MR. LANCE RONALD JACKSON NPI 1548581416

NPI Information

NPI: 1548581416
Provider Name: MR. LANCE RONALD JACKSON
Classification: Student in an Organized Health Care Education/Training Program - 390200000X
Entity Type: Individual
Address:
851 N OAKLAND AVE
PASADENA, CA
ZIP 91104
Phone: (626) 395-7100
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MR. Lance Ronald Jackson is a student in an organized health care education training program in Pasadena, CA. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. MR. Lance Ronald Jackson NPI is 1548581416. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

851 N OAKLAND AVE
PASADENA, CA
ZIP 91104-343
Phone: (626) 395-7100

The enumeration date for this NPI number is 6/15/2010 and was last updated on 1/23/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	225400000X	Rehabilitation Practitioner			CALIFORNIA	No
2	390200000X	Student in an Organized Health Care Education/Training Program				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	7068	MEDICAID	CALIFORNIA
2	6758	MEDICAID	CALIFORNIA
3	7420	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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