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Search › California › 390200000X

Philip Jackson

NPI 1003597071 · on the registry since 2023 · sole proprietor

Practice

Address
1902 Marengo St
Los Angeles, CA 90033
Phone
(323) 276-6470
Organisation at this address
Walgreen Co
Exodus Recovery Inc
Exodus Recovery Inc
Exodus Recovery, Inc.
Inferred from a shared address, not stated in the registry.
Clinicians at this address
9

Registry record

Primary taxonomy
390200000X
390200000X
Also registered as
101YA0400X
Licence states on file
CA
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2026-08-24

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California