Tatianie Alicia Jackson
ExpiredCalifornia license A127603
License
- Licensed by
- Medical Board of California
- License number
- A127603
- Status
- Expired (Delinquent)
- First issued
- October 3, 2013
- Expired
- May 31, 2023
- License holder
- Tatianie Alicia Jackson
- Entity type
- Individual
Classifications
- Physician and Surgeon A Physicians & Surgeons
More from the license record
- License type code
- 8002
Contact
4 Maple Leaf Dr
Old Forge, PA 18518-1611
Old Forge, PA 18518-1611
Lackawanna County