Healthcare Provider Details

I. General information

NPI: 1285241927
Provider Name (Legal Business Name): MS. JESSICA BOJORQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2020
Last Update Date: 09/27/2020
Certification Date: 09/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N NORMANDIE AVE APT 323
LOS ANGELES CA
90027-3979
US

IV. Provider business mailing address

PO BOX 27276
LOS ANGELES CA
90027-0276
US

V. Phone/Fax

Practice location:
  • Phone: 323-271-6523
  • Fax:
Mailing address:
  • Phone: 323-271-6523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number48046
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number48046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: