Dr. Ryan Patrick Jackson, M.D., Ph.D., M.Eng.
Pathology, Hematology in Duarte, CA. Individual provider (NPI-1).
NPI number1699153130
StatusActive
Last updated in NPPESMay 7, 2021
Details
- NPI
- 1699153130
- Entity type
- Individual (NPI-1)
- Name
- Dr. Ryan Patrick Jackson
- Credential
- M.D., Ph.D., M.Eng.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 18, 2015
- Certification date
- May 7, 2021
- Last updated
- May 7, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207ZH0000X | Pathology, Hematology | A150177 | CA | Yes |
| 207ZP0102X | Pathology, Anatomic Pathology & Clinical Pathology | A150177 | CA | |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
1500 Duarte RdDuarte, CA 91010-3012
Phone 626-256-4673
Mailing address
Po Box 512185Los Angeles, CA 90051-0185
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