Active NPI
Victoria Jackson
- Athletic Trainer
- Los Angeles, CA
National Provider Identifier
1295474161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2000050264
- Practice address
- 2131 John Wooden Ctr
Los Angeles, CA 90095-0001 - Phone
- (310) 206-0621
- NPI assigned
- May 31, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2000050264 | CA | Primary |
Addresses
Primary practice location
2131 John Wooden Ctr
Los Angeles, CA 90095-0001
Mailing address
11958 Bayla St
Norwalk, CA 90650-1827
Phone (562) 455-8756
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000050264 | CA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653955200000",
"number": "1295474161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11958 BAYLA ST",
"city": "NORWALK",
"state": "CA",
"postal_code": "906501827",
"telephone_number": "562-455-8756"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2131 JOHN WOODEN CTR",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900950001",
"telephone_number": "310-206-0621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "VICTORIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-31",
"last_updated": "2022-05-31",
"certification_date": "2022-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CA",
"license": "2000050264",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 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.