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DR. FAITH LEE-JACKSON MD

>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1699745471

Individual Registrant:
DR. FAITH  LEE-JACKSON MD
Gender: F
Not Sole Proprietor

Location and contact information for practice:
1700 NORTH WATERMAN AVENUE  SAN BERNANDINO, CA 92404-5105 US
Tel: 909-883-8611  Fax: 909-881-5707

Contact information for business:
1700 NORTH WATERMAN AVENUE  SAN BERNANDINO, CA 92404-5105 US
Tel: 909-883-8611  Fax: 909-883-8611

Registration Information:
NPI: 1699745471
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
CAA63452

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
OOA634520CA05




HEALTH CARE JOBS CA - Page 1



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