Provider Demographics
NPI:1891593794
Name:JACKSON, RONESHA NICOLE
Entity type:Individual
Prefix:
First Name:RONESHA
Middle Name:NICOLE
Last Name:JACKSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27206 CALAROGA AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4300
Mailing Address - Country:US
Mailing Address - Phone:510-881-5921
Mailing Address - Fax:844-830-2655
Practice Address - Street 1:27206 CALAROGA AVE STE 107
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4300
Practice Address - Country:US
Practice Address - Phone:510-881-5921
Practice Address - Fax:844-830-2655
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker