JIMMIE LEE JACKSON JR.
NPI 1124513783
Peer Specialist in San Diego, CA

Q: What is Jimmie Jackson's NPI number?

The NPI number for Jimmie Jackson is 1124513783. It was assigned to this individual provider in the NPPES registry on June 26, 2018.

Q: What is Jimmie Jackson's specialty?

The primary specialty registered for this NPI is Peer Specialist with taxonomy code 175T00000X.

Q: When was this NPI record last updated?

The NPPES record for Jimmie Jackson was last updated on July 2, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 26, 2018

1260 MORENA BLVD STE 100, SAN DIEGO, CA 92110(619) 398-0355 Get Directions Write a Review

NPPES record last updated: July 2, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 2, 2018, Jun 26, 2018 (2 updates tracked since 2018).

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About Jimmie Lee Jackson Jr. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JIMMIE LEE JACKSON JR. (NPI 1124513783) is an individual peer specialist in San Diego, California and active in the NPI registry since June 2018. He maintains a secondary practice location in San Diego.

NPPES Registry Identity

NPI1124513783

Entity TypeIndividualMale

Primary Taxonomy175T00000X

Provider Legal NameJIMMIE LEE JACKSON JR.

Location Address1260 MORENA BLVD STE 100San Diego, CA 92110

Mailing Address1260 Morena Blvd Ste 100San Diego, CA 92110-3850 · (619) 398-0355

Phone(619) 398-0355

Sole ProprietorNo

Enumeration DateJune 26, 2018

Last NPPES UpdateJuly 2, 20182 updates tracked since enumeration

✔ NPI 1124513783 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPeer SpecialistOther Service Providers

Taxonomy Code175T00000X

Definition

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

1260 MORENA BLVD STE 100, San Diego, CA 92110

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Secondary Practice Location 1

Location 11202 Morena Blvd Ste 300San Diego, CA 92110-3844 · Phone (619) 275-0822

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DAHARLIKA DEGRACIA

Case Manager/Care Coordinator