Robert Romulus Jackson I

Primary specialty

Rehabilitation PractitionerTaxonomy code 225400000X

Practice address

11600 Eldridge Ave
Sylmar, CA 91342-6506

Phone

(661) 208-9964

NPI assigned

Mar 17, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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": "1584403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749513600000",
    "number": "1164058657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11600 ELDRIDGE AVE",
            "city": "SYLMAR",
            "state": "CA",
            "postal_code": "913426506",
            "telephone_number": "661-208-9964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11600 ELDRIDGE AVE",
            "city": "SYLMAR",
            "state": "CA",
            "postal_code": "913426506",
            "telephone_number": "661-208-9964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ROBERT",
        "middle_name": "ROMULUS",
        "name_prefix": "Mr.",
        "name_suffix": "I",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-17",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rjackson@phoenixouseca.org",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11600 Eldridge Ave",
            "city": "Sylmar",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913426506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tiffany E Isichei
• Musumi Iwanaga, PHARM.D.,RPH
• Izacare Behavior Solutions, Inc.
• J Nathan Rubin M.D.
• Brandon Jackson, OTR/L
• Erica N Jadesimi
• Miles Jakl, M.D.
• James McCaffery MD a Professional Corp
• Jamie Fowler LCSW Inc
• Alejandro Jaramillo

• Rehabilitation Practitioner in Sylmar, CA
• Providers in Sylmar, CA by specialty
• Rehabilitation Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2025; 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.