Healthcare Provider Details

I. General information

NPI: 1326960147
Provider Name (Legal Business Name): JESSICA ER ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6833 WARNER AVE
HUNTINGTON BEACH CA
92647-5303
US

IV. Provider business mailing address

251 SANTA ANA AVE
LONG BEACH CA
90803-3562
US

V. Phone/Fax

Practice location:
  • Phone: 657-300-3616
  • Fax:
Mailing address:
  • Phone: 657-300-9764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number16003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: