Healthcare Provider Details

I. General information

NPI: 1932760022
Provider Name (Legal Business Name): JENNIFER LYNN MCISAAC HHP, CMT, CCMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5252 BALBOA AVE STE 706
SAN DIEGO CA
92117-2949
US

IV. Provider business mailing address

5252 BALBOA AVE STE 706
SAN DIEGO CA
92117-2949
US

V. Phone/Fax

Practice location:
  • Phone: 619-889-9912
  • Fax:
Mailing address:
  • Phone: 619-889-9912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7931
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number2003006141
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: