Individual
JESSICA LYN BODARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPO, CPO
Contact information
Practice address
895 THIRD AVE BLDG 2, CHULA VISTA, CA 91911-1304
(619) 585-8421
Mailing address
4117 IDAHO ST, SAN DIEGO, CA 92104-1805
(517) 528-7549
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
CPO04202
CA
224P00000X
Prosthetist
CPO04202
CA
Other
Enumeration date
04/23/2019
Last updated
04/23/2019
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