Jessica Annette Jackson

Primary specialty

Rehabilitation PractitionerTaxonomy code 225400000X

Practice address

4020 Civic Center Dr
San Rafael, CA 94903-4173

Phone

(415) 491-2548

NPI assigned

Dec 30, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jessica Annette Rodriguez Former name

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": "1451433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582156800000",
    "number": "1639534993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 RUSSELL ST",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945916543",
            "telephone_number": "415-573-6902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 CIVIC CENTER DR",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949034173",
            "telephone_number": "415-491-2548"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 Russell St",
            "address_purpose": "LOCATION",
            "city": "Vallejo",
            "state": "CA",
            "postal_code": "945916543",
            "country_code": "US",
            "telephone_number": "415-573-6902",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JESSICA",
        "middle_name": "ANNETTE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-30",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D3589691",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "RODRIGUEZ",
            "middle_name": "ANNETTE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Erin Ivison
• Bea Ivory-Chambers, LMFT
• Jeffrey Takashi Iwami, O.D.
• Samira Jaberi, DMD
• Floyd Jackson
• Phoenix Jackson
• Talita Calazans Jackson, MA, LMFT
• Larry Alan Jacobs, MFT
• Jessica Jacobson, MSW
• Jacqueline Kotula, DDS, Inc.

• Rehabilitation Practitioner in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Rehabilitation Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 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.