Healthcare Provider Details

I. General information

NPI: 1023345287
Provider Name (Legal Business Name): JILL L SLEIGHT ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 VENETIA DR
LONG BEACH CA
90803-3646
US

IV. Provider business mailing address

280 VENETIA DR
LONG BEACH CA
90803-3646
US

V. Phone/Fax

Practice location:
  • Phone: 310-567-7026
  • Fax: 310-726-0752
Mailing address:
  • Phone: 310-567-7026
  • Fax: 310-726-0752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: