Individual
MRS. JAMIE MARIE DEROLLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MBA, ATC
Contact information
Practice address
5151 PACIFIC AVE, STOCKTON, CA 95207-6304
(209) 954-5181
(209) 954-5696
Mailing address
5303 SPAULDING CT, RIVERBANK, CA 95367-9463
(209) 954-5181
(209) 954-5696
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
10/08/2014
Last updated
10/08/2014
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