JACK ANDERSON (NPI# 1982254603) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982254603 |
| Entity Type | Individual |
| Full Name | JACK ANDERSON |
| Practice Address |
14810 La Mesa Rd Victorville CA 92392-8639 |
| Practice Telephone | 7609510510 |
| Mailing Telephone | 7609510510 |
| Enumeration Date | 2019-09-14 |
| Last Update Date | 2019-09-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3747A0650X |
Technician Specialization: Attendant Care Provider |
Nursing Service Related Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154523470 | Jack Anderson | Chiropractor | 226 E 29th St Unit B, Loveland, CO 80538-2825 | 2007-05-31 |
| 1659338887 | Jack Anderson | Emergency Medicine | 9787 N 91st St Ste 101, Scottsdale, AZ 85258-5088 | 2006-05-01 |
| 1881166775 | Jack Raymond Anderson | Surgery | 1730 W 25th St, Cleveland, OH 44113-3108 | 2018-12-18 |
| 1245527969 | Jack D Anderson | Family Medicine | 1515 Edmonton Rd, Tompkinsville, KY 42167-9402 | 2011-07-01 |
| 1134330947 | Jack Glenn Anderson | Psychologist | 200 E Del Mar Blvd, Suite 122, Pasadena, CA 91105-2544 | 2007-05-24 |
| 1609948223 | Jack Martin Anderson | Pediatrics | 3003 Health Center Dr, San Diego, CA 92123-2700 | 2006-11-15 |
| 1417976234 | Jack D Anderson | Pediatrics | 7030 Pineville Matthews Rd, Charlotte, NC 28226-8298 | 2006-07-19 |
| 1992737522 | Jack Anderson | Internal Medicine | 2500 E Capitol Dr, Appleton, WI 54911-8735 | 2006-07-06 |
| 1811964000 | Jack W. Anderson | Anesthesiology | 470 Taylor Rd, Montgomery, AL 36117-3563 | 2006-03-07 |
| Street Address |
14810 LA MESA RD |
| City | VICTORVILLE |
| State | CA |
| Zip Code | 92392-8639 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861028540 | Verdelle Anderson | Technician | 14810 La Mesa Rd, Victorville, CA 92392-8639 | 2020-03-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215568688 | Kristin Parris | Behavior Technician | 15490 Civic Drive, Victorville, CA 92392 | 2020-02-03 |
| 1366001604 | Pine Ridge Treatment Centers, Inc. | Substance Abuse Rehabilitation Facility | 15367 Bonanza Rd, Ste A, Victorville, CA 92392 | 2019-06-11 |
| 1851871289 | Betty A. Murphy, Lmft, Inc | Marriage & Family Therapist | 15437 Anacapa Rd. Ste 26, Victorville, CA 92392 | 2018-08-15 |
| 1104313402 | Jorge L Soler Iglesias | Nurse Practitioner | 12459 Cricket St., Victorville, CA 92392 | 2018-04-23 |
| 1689192049 | Jamesina Johns | Nurse Practitioner | 12127 Mall Blvd #148, Victorville, CA 92392 | 2017-09-06 |
| 1285151886 | Jasmin Sanchez | Behavioral Analyst | 13201 Eclipse Ave, Victorville, CA 92392 | 2017-08-24 |
| 1174049829 | Virginia Marshall | Behavioral Analyst | 13901 Amargosa Rd., Victorville, CA 92392 | 2017-08-15 |
| 1346781465 | San Bernardino Conty | Counselor | 15480 Ramona Ave., Victoville, CA 92392 | 2017-03-09 |
| 1841741279 | Lorinda Morreale | Marriage & Family Therapist | 15428 Civic Dr. Ste 200, Act Family Counseling, Victorville, CA 92392 | 2016-10-20 |
| 1235582404 | Greater Hope Foundation | Community/Behavioral Health | 14344 Cajon Avenue, Suite 101, 103, Victorville, CA 92392 | 2016-07-22 |
| Find all providers in zip 92392 | ||||
| Taxonomy Code | 3747A0650X |
| Grouping | Nursing Service Related Providers |
| Classification | Technician |
| Specialization | Attendant Care Provider |
| An individual who provides hands-on care, of both a supportive and health related nature, specific to the needs of a medically stable, physically handicapped individual. Supportive services are those that substitute for the absence, loss, diminution, or impairment of a physical or cognitive function. This service may include skilled or nursing care to the extent permitted by state law. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215588454 | Irene Fay Lucious | Technician | 14072 Mare Ln, Victorville, CA 92394-7527 | 2019-09-27 |
| 1861028540 | Verdelle Anderson | Technician | 14810 La Mesa Rd, Victorville, CA 92392-8639 | 2020-03-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700487691 | Hine Maumalanga | Technician | 1094 Folsom Ave, Hayward, CA 94544-5704 | 2020-11-05 |
| 1649871765 | Charles Leroy Appleberry II | Technician | 1100 S Chester Ave, Compton, CA 90221-4312 | 2020-11-04 |
| 1902407174 | Ryan Allen Merrell | Technician | 313 E. 17th Pl #l Costa Mesa, Costa Mesa, CA 92627 | 2020-11-04 |
| 1083212476 | Christina Elisabeth Brunn | Technician | 2818 Huxley Pl, Fremont, CA 94555-1416 | 2020-10-16 |
| 1790392165 | Amanda Moore | Technician | 6445 Village Center Dr, Building 7 Apt 101, Sacramento, CA 95823 | 2020-09-29 |
| 1730795543 | Corina Rochelle Burch | Technician | 3706 Calavo Dr, Spring Valley, CA 91977-1903 | 2020-09-17 |
| 1033724729 | Cinta Latrece Moore | Technician | 12329 Creekview Dr Unit 37, San Diego, CA 92128-6624 | 2020-09-10 |
| 1598379398 | Trina Diane Brown | Technician | 115 W Zane St, Long Beach, CA 90805-6327 | 2020-08-31 |
| 1437760766 | Jeri Lyn Allen-smith | Technician | 9228 Allano Way, Santee, CA 92071-2202 | 2020-08-11 |
| 1750991667 | Natalie Mari Norman | Technician | 5013 Englewood Dr, San Jose, CA 95129-4232 | 2020-08-05 |
| Find all providers with the same taxonomy | ||||
| City | VICTORVILLE |
| Zip Code | 92392 |
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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.