Provider Demographics
NPI:1639264864
Name:JACKSON, CHRISTIAN STERLING (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:STERLING
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:LOMA LINDA VA MEDICAL CENTER 11201 BENTON STREET
Mailing Address - Street 2:3A-58/111G
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354
Mailing Address - Country:US
Mailing Address - Phone:909-825-7084
Mailing Address - Fax:909-777-3260
Practice Address - Street 1:LOMA LINDA VA MEDICAL CENTER 11201 BENTON STREET
Practice Address - Street 2:3A-58/111G
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354
Practice Address - Country:US
Practice Address - Phone:909-825-7084
Practice Address - Fax:909-777-3260
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist