BRIAN JAMES JACKSON (NPI# 1194985861) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194985861 |
| Entity Type | Individual |
| Full Name | BRIAN JAMES JACKSON |
| Credential | IDC |
| Practice Address |
35000 Guadalcanal Ave San Diego CA 92140-5599 |
| Practice Telephone | 6195244045 |
| Mailing Telephone | 6195244045 |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2008-06-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083198659 | Brian John Jackson | Physician Assistant | 391 Lee Blvd Ste 300, Lehigh Acres, FL 33936-4973 | 2018-09-19 |
| 1316482425 | Brian Keith Jackson | Community Health Worker | 3714 Ruffin Rd, North Prince George, VA 23860-8629 | 2016-12-28 |
| 1346610011 | Brian Jackson | Counselor | 3008 Conmar St, Shreveport, LA 71108 | 2015-10-06 |
| 1255421855 | Brian R Jackson | Pathology | 500 E Chipeta Way, Salt Lake City, UT 84108-1221 | 2006-10-13 |
| 1467497461 | Brian D Jackson | Allergy & Immunology | 151 Harmony Park Circle, Hot Springs, AR 71913 | 2006-06-17 |
| 1689665408 | Brian E Jackson | Dentist | 2775 Bishop Rd, Suite C, Willoughby Hills, OH 44092-2683 | 2005-11-01 |
| 1306842356 | Brian D Jackson | Podiatrist | 1215 Hatcher Ln, Columbia, TN 38401-3531 | 2005-06-23 |
| 1477150738 | Brian Leslie Jackson | Registered Nurse | 2751 Napa Valley Corporate Dr Bldg B, Napa, CA 94558-6216 | 2020-10-08 |
| 1558973115 | Brian Lee Jackson | Pharmacist | 5780 Terry Rd, Byram, MS 39272-9745 | 2020-08-17 |
| 1174080030 | Brian Jeffry Jackson | Nurse Practitioner | 2075 San Joaquin Hills Rd, Newport Beach, CA 92660-6505 | 2019-02-27 |
| Street Address |
35000 GUADALCANAL AVE |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92140-5599 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396717492 | Douglas Lee Faison | Physician Assistant | 35000 Guadalcanal Ave, Branch Medical Clinic, Mcrd Bld 596, San Diego, CA 92140-5599 | 2006-02-02 |
| 1780938209 | Naval Medical Center San Diego | Military Hospital | 35000 Guadalcanal Ave, Bldg 596, San Diego, CA 92140 | 2012-11-06 |
| 1073773800 | Ehren Lietz | Military Health Care Provider | 35000 Guadalcanal Ave, San Diego, CA 92140-5599 | 2008-06-16 |
| 1386802874 | Veronyka T Young | Military Health Care Provider | 35000 Guadalcanal Ave, San Diego, CA 92140-5599 | 2008-05-30 |
| 1427224161 | Lisa Kay Lawitzke-hundley | Military Health Care Provider | 35000 Guadalcanal Ave, Bldg 596, San Diego, CA 92140-5599 | 2008-05-02 |
| 1417129370 | Donald Reid Rosario | Military Health Care Provider | 35000 Guadalcanal Ave, Bldg 596, San Diego, CA 92140-5599 | 2008-03-31 |
| 1396922464 | Brian Patrick Livingstone | Specialist/Technologist | 35000 Guadalcanal Ave, San Diego, CA 92140-5599 | 2008-01-30 |
| 1851587075 | Timothy Wayne Sefa | Military Health Care Provider | 35000 Guadalcanal Ave, San Diego, CA 92140-5599 | 2007-09-20 |
| 1588854368 | Eduardo Malayao Magpayo | Military Health Care Provider | 35000 Guadalcanal Ave, San Diego, CA 92140-5599 | 2007-07-27 |
| 1457571044 | Michael A. Carter | Specialist/Technologist | 35000 Guadalcanal Ave, San Diego, CA 92140-5599 | 2007-04-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528549177 | Shelly K Gareiss | Dentist | Mcrd San Diego, 3800 Chosin Avenue, San Diego, CA 92140 | 2018-08-22 |
| 1700185303 | Rachel Ann Holloway | Physician Assistant | 35000 Guadalcanal Street, Bhc Mcrd, San Diego, CA 92140 | 2011-03-22 |
| 1215158027 | Susan Rohbock | Physician Assistant | Navy Medical Clinic - Marine Corps Recruit Depot, 35000 Guadalcanal St., San Diego, CA 92140 | 2007-05-01 |
| 1700927514 | Anthony Joseph Marciante | Dentist | Branch Dental Clinic Mcrd, 43000 Midway Ave, Bldg 595, San Diego, CA 92140 | 2007-02-12 |
| 1861539488 | Justin Oderkirk | Emergency Medical Technician, Basic | 1650 Henderson Ave, Bldg 310, San Diego, CA 92140 | 2007-01-31 |
| 1437240777 | Karima Ayesh | Dentist | 34000 Midway Ave, Bldg 595, Apo, AA 92140 | 2006-09-28 |
| 1730288788 | Naval Medical Center San Diego | Military/U.S. Coast Guard Pharmacy | 25000 Guadal Canal Rd, Bldg 256, San Diego, CA 92140 | 2006-09-22 |
| 1306800644 | Reynaldo L Reyes Jr. | Military Health Care Provider | 35000 Guadalcanal St, Branch Medical Clinic Marine Corps Recruit Depot, San Diego, CA 92140 | 2006-04-13 |
| 1932161197 | Reynaldo Aldover Guadez | Military Health Care Provider | Branch Medical Clinic Mcrd, 35000 Guadalcanal Street, San Diego, CA 92140 | 2006-04-04 |
| 1730151648 | Richard William Skinner | General Practice | Branch Clinic Marine Corps Recruit Depot, 35000 Guadalcanal Ave, San Diego, CA 92140 | 2006-02-03 |
| Find all providers in zip 92140 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770180648 | Darius Lee Sean Woods | Military Health Care Provider | 6033 Sandy Shore Ct, San Diego, CA 92139-1014 | 2020-10-05 |
| 1174130744 | Daniel Carrera | Military Health Care Provider | 2645 W Canyon Ave Apt 450, San Diego, CA 92123-4700 | 2020-09-28 |
| 1316551740 | Kyle Bode Francis | Military Health Care Provider | 3149 Murray Ridge Rd, San Diego, CA 92123-2917 | 2020-09-02 |
| 1255945069 | Jeremy Lee | Military Health Care Provider | 509 Dennery Rd Apt 145, San Diego, CA 92154-8542 | 2020-08-31 |
| 1013520667 | Rashaad Brown | Military Health Care Provider | 4454 Cherokee Ave Apt 2, San Diego, CA 92116-3611 | 2020-08-24 |
| 1932711934 | Alvaro Daniel Macias | Military Health Care Provider | 8685 Rio San Diego Dr Apt 4344, San Diego, CA 92108-6560 | 2020-08-20 |
| 1689286189 | Charles Luke Morris | Military Health Care Provider | 1675 Beta Ct, San Diego, CA 92126-7060 | 2020-08-18 |
| 1255943635 | Stephon Peyton Frost | Military Health Care Provider | 2654 Mendonca Dr, San Diego, CA 92110-4263 | 2020-08-18 |
| 1184235871 | Jaden Sandi | Military Health Care Provider | Swmi Sfidc Bldg 14 34101 Farenholt Ave, San Diego, CA 92134-0001 | 2020-08-14 |
| 1477178457 | Joseph Hunter Sampson | Military Health Care Provider | 34101 Farenholt Ave #14, San Diego, CA 92134 | 2020-06-15 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.