Healthcare Provider Details

I. General information

NPI: 1477488062
Provider Name (Legal Business Name): JAYE FISHEL CMT, SEP
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 VALENTINE ST
LOS ANGELES CA
90026-2015
US

IV. Provider business mailing address

2209 VALENTINE ST
LOS ANGELES CA
90026-2015
US

V. Phone/Fax

Practice location:
  • Phone: 415-686-8217
  • Fax:
Mailing address:
  • Phone: 415-686-8217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number83096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: