Healthcare Provider Details

I. General information

NPI: 1881929479
Provider Name (Legal Business Name): JESSICA ANN DELAROSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 W CLEARWATER AVE STE. F.
KENNEWICK WA
99336-2767
US

IV. Provider business mailing address

2341 SUNSET WAY
COWICHE WA
98923-9718
US

V. Phone/Fax

Practice location:
  • Phone: 509-969-3792
  • Fax: 509-783-6675
Mailing address:
  • Phone: 509-969-3792
  • Fax: 509-783-6675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60111627
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: