Individual
JACKSON WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3484 MONROE ST APT 5, SANTA CLARA, CA 95051-1434
(805) 341-7751
Mailing address
3484 MONROE ST APT 5, SANTA CLARA, CA 95051-1434
(805) 341-7751
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
4467
CA
Other
Enumeration date
09/30/2022
Last updated
09/30/2022
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