Provider Demographics
NPI:1528374808
Name:JACKSON, SHARI F
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:F
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12423 DAHLIA AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-3611
Mailing Address - Country:US
Mailing Address - Phone:626-258-0329
Mailing Address - Fax:626-401-0027
Practice Address - Street 1:12423 DAHLIA AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3611
Practice Address - Country:US
Practice Address - Phone:626-258-0329
Practice Address - Fax:626-401-0027
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator