Active NPI
Mia Lanise Jackson, LVN
- Licensed Vocational Nurse
- Mission Viejo, CA
National Provider Identifier
1609598408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Vocational Nurse
- License
- 689359
- Practice address
- 26921 Crown Valley Pkwy Ste 200
Mission Viejo, CA 92691-6501 - Phone
- (949) 334-8288
- Fax
- (949) 334-8294
- NPI assigned
- Sep 19, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 689359 | CA | Primary |
Addresses
Primary practice location
26921 Crown Valley Pkwy Ste 200
Mission Viejo, CA 92691-6501
Mailing address
34264 Chaparossa Dr
Lake Elsinore, CA 92532-2919
Phone (951) 259-6061
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 |
|---|---|---|---|
| 689359 | CA | MD | Licensed Vocational Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786406400000",
"number": "1609598408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34264 CHAPAROSSA DR",
"city": "LAKE ELSINORE",
"state": "CA",
"postal_code": "925322919",
"telephone_number": "951-259-6061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26921 CROWN VALLEY PKWY STE 200",
"city": "MISSION VIEJO",
"state": "CA",
"postal_code": "926916501",
"telephone_number": "949-334-8288",
"fax_number": "949-334-8294"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MIA",
"middle_name": "LANISE",
"credential": "LVN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-09-19",
"last_updated": "2026-08-11",
"certification_date": "2026-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "CA",
"license": "689359",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mission Viejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.