Active NPI
Cynthia Monique Jackson, RDH
- Dental Hygienist
- Vista, CA
National Provider Identifier
1750043402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 34554
- Practice address
- 1000 Vale Terrace Dr
Vista, CA 92084-5218 - Phone
- (760) 631-5000
- NPI assigned
- Oct 11, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 13078 | NC | |
| Dental Hygienist | 124Q00000X | 34554 | CA | Primary |
Addresses
Primary practice location
1000 Vale Terrace Dr
Vista, CA 92084-5218
Mailing address
269 Tamayo CT Apt 10
Oceanside, CA 92058-8458
Phone (702) 857-0021
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 |
|---|---|---|---|
| 34554 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633910400000",
"number": "1750043402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "269 TAMAYO CT APT 10",
"city": "OCEANSIDE",
"state": "CA",
"postal_code": "920588458",
"telephone_number": "702-857-0021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 VALE TERRACE DR",
"city": "VISTA",
"state": "CA",
"postal_code": "920845218",
"telephone_number": "760-631-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CYNTHIA",
"middle_name": "MONIQUE",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-10-11",
"last_updated": "2021-10-11",
"certification_date": "2021-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "NC",
"license": "13078",
"primary": false
},
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CA",
"license": "34554",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vista, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.