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General NPI Number Information
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NPI Number | 1801482765
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Entity Type | Individual
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Provider Name | JESSICA MATTHEWS DBH, NBC-HWC
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Gender | Female
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Dates
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Enumeration Date | 12/15/2020
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 5060 SHOREHAM PL STE 330
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City | SAN DIEGO
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State | CA
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Zip | 92122-5976
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Country | US
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Telephone | 858-249-6895
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7472
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City | SAN DIEGO
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State | CA
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Zip | 92167-0472
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Country | US
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Telephone |
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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 | 240970021
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License Number State |
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