Healthcare Provider Details

I. General information

NPI: 1023286994
Provider Name (Legal Business Name): JAMILAH EL ELITE MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAMILAH ELITE MORRIS MASSAGE THERAPIST

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 2ND AVE STE 302
CROCKETT CA
94525-1176
US

IV. Provider business mailing address

1012 CHELSEA
HERCULES CA
94547-3848
US

V. Phone/Fax

Practice location:
  • Phone: 510-435-7772
  • Fax: 510-787-7704
Mailing address:
  • Phone: 510-435-7772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: