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Individual

JENELLE HELENE EZCURRA SANDY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
AUD

Contact information

Practice address
2074 LAKE TAHOE BLVD, SOUTH LAKE TAHOE, CA 96150-6407
(530) 318-4010
Mailing address
1285 APACHE AVE # 306, SOUTH LAKE TAHOE, CA 96155-7672
(530) 318-4010

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
147001386
IL
231H00000X
Audiologist
A3154
NV
231H00000X
Audiologist
Primary
AU3526
CA

Other

Enumeration date
07/27/2011
Last updated
03/22/2022
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