Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Andre Wayne Jackson, OTHER

Individual provider Durable Medical Equipment & Medical Supplies · NPI 1174452387

Andre Wayne Jackson, OTHER is a Durable Medical Equipment & Medical Supplies in Richmond, California. Practices as a sole proprietor. Licensed in California.

Licensed in
CA
In the registry since
2026

Practice location Address checks out

2930 Hilltop Mall Rd Ste B
Richmond, CA 94806-2197
Phone: (510) 222-1075
Fax: (866) 665-8815
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Durable Medical Equipment & Medical Supplies (primary) Taxonomy 332B00000X · Licence 101135 (CA)

Record details

NPI number1174452387
Entity typeIndividual (Type 1)
GenderMale
Credentials OTHER
Sole proprietorYes
NPI enumeratedMay 14, 2026
Last updated in NPPESMay 14, 2026
Certification dateMay 14, 2026
Mailing address2930 Hilltop Mall Rd Ste B, Richmond, CA 94806-2197

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