Healthcare Provider Details

I. General information

NPI: 1477762045
Provider Name (Legal Business Name): MRS. JESSICA HEATHER KRIEGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 E BIRCH ST APT 10
BREA CA
92821-5547
US

IV. Provider business mailing address

404 E BIRCH ST APT 10
BREA CA
92821-5547
US

V. Phone/Fax

Practice location:
  • Phone: 562-841-4312
  • Fax:
Mailing address:
  • Phone: 562-841-4312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberOTA 597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: