MR. JACARI DA VON JACKSON (NPI# 1790277648) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790277648 |
| Entity Type | Individual |
| Full Name | MR. JACARI DA VON JACKSON |
| Practice Address |
2640 Industry Way Lynwood CA 90262-4284 |
| Practice Telephone | 3106274525 |
| Mailing Telephone | 3106274525 |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2019-07-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
ASW89841 | CA | Behavioral Health & Social Service Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 333 S. Beaudry Avenue, Los Angeles, CA 900171466 | 2132413841 | 2132413305 |
| Street Address |
2640 INDUSTRY WAY |
| City | LYNWOOD |
| State | CA |
| Zip Code | 90262-4284 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831173970 | Russell F. Lim | Psychiatry & Neurology | 2640 Industry Way, Lynwood, CA 90262-4284 | 2005-12-02 |
| 1467053603 | Jaquenette Miller | Case Manager/Care Coordinator | 2640 Industry Way, Lynwood, CA 90262-4284 | 2020-11-04 |
| 1720685233 | Russell Smith | Case Manager/Care Coordinator | 2640 Industry Way, Lynwood, CA 90262-4284 | 2020-10-07 |
| 1629675343 | Destiny Williams-panell | Case Manager/Care Coordinator | 2640 Industry Way, Lynwood, CA 90262-4284 | 2020-10-06 |
| 1104438589 | Elizabeth Navarro | Case Manager/Care Coordinator | 2640 Industry Way, Lynwood, CA 90262-4284 | 2020-08-18 |
| 1265056162 | Debbie Diane Smith | Case Manager/Care Coordinator | 2640 Industry Way, Lynwood, CA 90262-4284 | 2020-06-05 |
| 1538782354 | Jason Douglas Delacuz | Licensed Vocational Nurse | 2640 Industry Way, Lynwood, CA 90262-4284 | 2020-05-27 |
| 1700418548 | Lidia Minerva Haefele | Counselor | 2640 Industry Way, Lynwood, CA 90262-4284 | 2020-02-10 |
| 1396377495 | Adam Castillo | Counselor | 2640 Industry Way, Lynwood, CA 90262-4284 | 2020-02-06 |
| 1073145355 | Aaron Sanderlin | Case Manager/Care Coordinator | 2640 Industry Way, Lynwood, CA 90262-4284 | 2020-02-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811546062 | Sheila Maxine Wilkins | Technician | 3940 Palm Ave, Lynwood, CA 90262 | 2019-09-10 |
| 1891344669 | Chezoma Latissue Davis | Technician | 4255 Niland St, Lynwood, CA 90262 | 2019-09-05 |
| 1295223345 | Scla Comprehensive Surgical Medical Group, Inc. | Clinic/Center | 3628 E Imperial Hwy Ste 204, Lynwood, CA 90262 | 2018-04-24 |
| 1891213807 | Grecia Veronica Nunez | Case Manager/Care Coordinator | 3680 E. Imperial Highway, Suite 200, Lynwood, CA 90262 | 2017-08-30 |
| 1134643448 | Angelica Jazmin Alonso Cortes | Case Manager/Care Coordinator | 2610 Industry Way Suite A, Lynwood, CA 90262 | 2017-07-28 |
| 1134594997 | Corinne Palma | Counselor | 11705 S. Alameda St., Lynwood, CA 90262 | 2015-12-04 |
| 1891175550 | Nancy Bremmer | Counselor | 10705 S. Alameda Street, Los Angels, CA 90262 | 2015-06-08 |
| 1588041347 | Jennifer Montoya | Case Management | 5433 E. Pelleur St., Lynwood, CA 90262 | 2015-04-30 |
| 1124440060 | Susana Gyek Goy | Chiropractor | 11123 Long Beach Blvd. Suite 5, Lynwood Health Center, Lynwood, CA 90262 | 2014-01-13 |
| 1215368956 | Baart Community Healthcare | Clinic/Center | 11315 S. Atlantic Blvd., Lynwood, CA 90262 | 2013-12-05 |
| Find all providers in zip 90262 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700307741 | Makenzie Anne Muilenburg | Counselor | 4807 196th St Sw (floor 2), Lynwood, WA 98306 | 2017-06-29 |
| 1649723487 | Roxana Chavez | Counselor | 3680 E Imperial Hwy Ste 200, Lynwood, CA 90262-2663 | 2016-07-28 |
| 1316303605 | Karen S. Keeton | Counselor | 19101 36th Avenue West, Suite 208, Lynwood, WA 98036 | 2016-01-03 |
| 1134594997 | Corinne Palma | Counselor | 11705 S. Alameda St., Lynwood, CA 90262 | 2015-12-04 |
| 1487929501 | Janet F Stewart-lofton | Counselor | 19805 Crescent Ave, Lynwood, IL 60411-1413 | 2012-03-22 |
| 1427207430 | Beatriz Jimenez Duenas | Counselor | 3823 Le Sage St, Lynwood, CA 90262-2821 | 2008-09-15 |
| 1447412283 | Maria Jose Romero | Counselor | 11000 California Ave, Lynwood, CA 90262-2502 | 2008-07-01 |
| 1346436540 | Beatriz Gonzalez | Counselor | 3680 E. Imperial Hwy., 2nd Floor Suite #220, Lynwood, CA 90262-3805 | 2007-09-20 |
| 1700913688 | Jordon Epps | Counselor | 3737 Martin Luther King Jr Blvd Ste 550, Lynwood, CA 90262-3536 | 2007-02-27 |
| 1538295449 | Yesenia Maria Carmona | Counselor | 2620 Industry Way, Lynwood, CA 90262 | 2007-02-26 |
| Find all providers in LYNWOOD | ||||
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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.