Healthcare Provider Details

I. General information

NPI: 1023927712
Provider Name (Legal Business Name): ELIZABETH CHRISTODOULOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13910 LYONS VALLEY RD STE L
JAMUL CA
91935-2028
US

IV. Provider business mailing address

13910 LYONS VALLEY RD STE L
JAMUL CA
91935-2028
US

V. Phone/Fax

Practice location:
  • Phone: 619-502-9333
  • Fax:
Mailing address:
  • Phone: 619-502-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: