IndividualActive
Donald Jack, M.D.
NPI 1497079875 · Basic Emergency Medical Technician · Hollywood, CA
Provider details
- NPI number
- 1497079875
- Entity type
- Individual
- Primary specialty
- Basic Emergency Medical TechnicianEmergency Medical Service Providers
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- Yes
- License
- 12521464546464 (KY)
Specialties & taxonomies
Emergency Medical Service Providers
Practice location
1644 Wilcox Ave
Hollywood, CA 90028-6206
Phone: (424) 202-0322
Approximate (ZIP-level) locationGet directions
Mailing address
180 E. Providencia Ave.
Burbank, CA 91205
Registry dates
- Enumerated
- 2010-03-15
- Last updated
- 2010-03-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.