MEDICARE: JESSAMINE DOWNS

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	225100000X	Physical Therapist	33969	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33969	OTHER	CA	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1942645999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSAMINE DOWNS

Provider Business Mailing Address
First Line	:	14349 AEDAN CT
Second Line	:
City	:	POWAY
State	:	CA
Zip	:	92064-3320
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1922 N BROADWAY
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92706-2610
Country	:	US
Telephone Number	:	714-901-4200
Fax Number	:

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

Provider Enumeration Date	:	05/03/2013
Last Update Date	:	05/03/2013

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