Anita C. Jackson, M.D., Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

A053675 Issued in CA

Legal business name

ANITA C. JACKSON, M.D., INC

Practice address

31720 Highway 79 South
Suite 203
Temecula, CA 92592

Phone

(951) 694-4688

Fax

(951) 694-4760

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Anita C Jackson, MD

Title

President

Phone

(951) 694-4688

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1326145756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31720 HIGHWAY 79 SOUTH",
            "address_2": "SUITE 203",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "92592",
            "telephone_number": "951-694-4688",
            "fax_number": "951-694-4760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31720 HIGHWAY 79 SOUTH",
            "address_2": "SUITE 203",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "92592",
            "telephone_number": "951-694-4688",
            "fax_number": "951-694-4760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANITA C. JACKSON, M.D., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ANITA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-694-4688",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A053675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Temecula, CA
• Providers in Temecula, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.