Angelique Allyssa Jackson

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

2122 S El Camino Real Ste 201
Oceanside, CA 92054-6210

Phone

(760) 290-8170

Fax

(760) 439-0019

NPI assigned

Jan 11, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Angelique Allyssa Hays Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641859200000",
    "number": "1104577147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 S EL CAMINO REAL STE 201",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920546210",
            "telephone_number": "760-290-8170",
            "fax_number": "760-439-0019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2122 S EL CAMINO REAL STE 201",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920546210",
            "telephone_number": "760-290-8170",
            "fax_number": "760-439-0019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ANGELIQUE",
        "middle_name": "ALLYSSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-11",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELIQUE",
            "last_name": "HAYS",
            "middle_name": "ALLYSSA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jon Izzo
• J Walker Chiropractic
• J.E.M. Clinical Counseling, LLC
• Ja Precious Inc.
• Leanne D Jack, LVN
• Clara Alexandra Jackson
• Dominique Jackson
• Michelle Jackson, MD
• Steven Jackson, PT
• Jacob N Flores

• Peer Specialist in Oceanside, CA
• Providers in Oceanside, CA by specialty
• Peer Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.