Healthcare Provider Details

I. General information

NPI: 1588519805
Provider Name (Legal Business Name): DENISSE JARA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72490 EL CENTRO WAY APT 117
THOUSAND PALMS CA
92276-3434
US

IV. Provider business mailing address

72490 EL CENTRO WAY APT 117
THOUSAND PALMS CA
92276-3434
US

V. Phone/Fax

Practice location:
  • Phone: 760-808-1782
  • Fax:
Mailing address:
  • Phone: 760-808-1782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number101307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: