Individual
MS. JENNIESE WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
11 CANYON LAKE DR, PORT COSTA, CA 94569-1003
(415) 279-3410
Mailing address
PO BOX 123, PORT COSTA, CA 94569-0123
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
22654
CA
Other
Enumeration date
09/01/2022
Last updated
09/01/2022
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