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General NPI Number Information
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NPI Number | 1720446495
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Entity Type | Individual
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Provider Name | RICKEY JASPER II II NASM, CPT
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Gender | Male
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Dates
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Enumeration Date | 02/09/2016
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Last Update Date | 02/09/2016
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Provider Practice Location Address
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Address Line | 2979 ESCALA CIR
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City | SAN DIEGO
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State | CA
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Zip | 92108-6723
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Country | US
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Telephone | 703-967-2186
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Fax |
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Provider Business Mailing Address
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Address Line | 20707 MANDALAY CT
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City | ASHBURN
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State | VA
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Zip | 20147-2836
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Country | US
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Telephone | 703-967-2186
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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 | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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