Individual
JESSIE TAVARRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12555 LAKEWOOD BLVD STE F, DOWNEY, CA 90242-2771
(562) 923-4704
Mailing address
544 S DEVON RD, ORANGE, CA 92868-4520
(714) 244-6660
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA48319
CA
Other
Enumeration date
03/10/2021
Last updated
03/10/2021
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