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General NPI Number Information
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NPI Number | 1053643114
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Entity Type | Individual
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Provider Name | JOLENE DECIUTIIS HHP
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Gender | Female
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Dates
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Enumeration Date | 01/31/2010
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Last Update Date | 01/31/2010
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Provider Practice Location Address
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Address Line | 2740 ROOSEVELT ST
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City | CARLSBAD
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State | CA
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Zip | 92008-2385
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Country | US
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Telephone | 760-822-1587
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Fax |
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Provider Business Mailing Address
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Address Line | 1605 WESLEY WAY
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City | VISTA
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State | CA
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Zip | 92081-7458
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Country | US
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Telephone | 760-822-1587
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State | CA
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