Robert Romulus Jackson I
Rehabilitation Practitioner in Sylmar, CA. Individual provider (NPI-1).
NPI number1164058657
StatusActive
Last updated in NPPESJun 10, 2025
Details
- NPI
- 1164058657
- Entity type
- Individual (NPI-1)
- Name
- Mr. Robert Romulus Jackson I
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 17, 2020
- Certification date
- Jun 10, 2025
- Last updated
- Jun 10, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225400000X | Rehabilitation Practitioner | – | – | Yes |
| 171M00000X | Case Manager/Care Coordinator | – | CA |
Practice location
11600 Eldridge AveSylmar, CA 91342-6506
Phone 661-208-9964
Mailing address
11600 Eldridge AveSylmar, CA 91342-6506
Phone 661-208-9964
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