Active NPI
Jenna Jackson, R.D.
- Registered Dietitian
- Mission Hills, CA
National Provider Identifier
1417334681
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1071091
- Practice address
- 11165 Sepulveda Blvd
Mission Hills, CA 91345-1113 - Phone
- (866) 837-5779
- NPI assigned
- Apr 27, 2015
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1071091 | CA | Primary |
Addresses
Primary practice location
11165 Sepulveda Blvd
Mission Hills, CA 91345-1113
Mailing address
4322 Matilija Ave
Apt 2
Sherman Oaks, CA 91423-3624
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 |
|---|---|---|---|
| 1071091 | CA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430092800000",
"number": "1417334681",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4322 MATILIJA AVE",
"address_2": "APT 2",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "914233624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11165 SEPULVEDA BLVD",
"city": "MISSION HILLS",
"state": "CA",
"postal_code": "913451113",
"telephone_number": "866-837-5779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "JENNA",
"credential": "R.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-04-27",
"last_updated": "2015-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "1071091",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mission Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.