MEDICARE: JESSICA ELIZABETH KNIGHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1316550510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ELIZABETH KNIGHT

Provider Business Mailing Address
First Line	:	6383 ALVARADO CT
Second Line	:	310
City	:	SAN DIEGO
State	:	CA
Zip	:	92120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6383 ALVARADO CT
Second Line	:	310
City	:	SAN DIEGO
State	:	CA
Zip	:	92120
Country	:	US
Telephone Number	:	858-277-9550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2020
Last Update Date	:	08/26/2020

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