Mikel James Jackson, ATC
Specialist/Technologist, Athletic Trainer in Oakland, CA. Individual provider (NPI-1).
NPI number1679994263
StatusActive
Last updated in NPPESDec 26, 2013
Details
- NPI
- 1679994263
- Entity type
- Individual (NPI-1)
- Name
- Mr. Mikel James Jackson
- Credential
- ATC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 26, 2013
- Last updated
- Dec 26, 2013
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | – | – | Yes |
Practice location
1832 101st AveOakland, CA 94603-3304
Phone 408-799-1230
Mailing address
Po Box 761San Leandro, CA 94577-0435
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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