Individual
JILL DAVENPORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMP
Contact information
Practice address
11965 VENICE BLVD, SUITE 209, LOS ANGELES, CA 90066-3979
(424) 209-9716
Mailing address
11965 VENICE BLVD, SUITE 209, LOS ANGELES, CA 90066-3979
(424) 209-9716
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
26982
CA
Other
Enumeration date
10/02/2012
Last updated
10/02/2012
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