Provider Demographics
NPI:1063519486
Name:JACKSON, ANITA CAL (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:CAL
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1545 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3814
Mailing Address - Country:US
Mailing Address - Phone:951-791-1111
Mailing Address - Fax:888-856-3893
Practice Address - Street 1:44274 GEORGE CUSHMAN CT STE 212
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5945
Practice Address - Country:US
Practice Address - Phone:951-694-4688
Practice Address - Fax:888-827-3492
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-07-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA053675207QG0300X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine