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General NPI Number Information
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NPI Number | 1932760022
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Entity Type | Individual
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Provider Name | JENNIFER LYNN MCISAAC HHP, CMT, CCMH
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Gender | Female
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Dates
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Enumeration Date | 06/28/2019
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 5252 BALBOA AVE STE 706
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City | SAN DIEGO
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State | CA
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Zip | 92117-2949
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Country | US
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Telephone | 619-889-9912
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Fax |
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Provider Business Mailing Address
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Address Line | 5252 BALBOA AVE STE 706
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City | SAN DIEGO
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State | CA
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Zip | 92117-2949
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Country | US
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Telephone | 619-889-9912
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 7931
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | 2003006141
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License Number State |
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