Individual
JACQUELINE VANESSA RANDOLPH PERDOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3221 BLUFF VIEW CT APT 204, WOODBRIDGE, VA 22192-1763
(703) 945-3393
Mailing address
3221 BLUFF VIEW CT APT 204, WOODBRIDGE, VA 22192-1763
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
VA
225700000X
Massage Therapist
0019019815
VA
Other
Enumeration date
02/05/2026
Last updated
02/05/2026
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