Healthcare Provider Details

I. General information

NPI: 1982904678
Provider Name (Legal Business Name): JES THOMPSON L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 MISSION BLVD SUITE 7
SAN DIEGO CA
92109-2541
US

IV. Provider business mailing address

4747 MISSION BLVD SUITE 7
SAN DIEGO CA
92109-2541
US

V. Phone/Fax

Practice location:
  • Phone: 619-980-7911
  • Fax:
Mailing address:
  • Phone: 619-980-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 13730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: