Individual
JESSIE JORGE DE LA PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
6817 SOUTHPOINT PKWY, JACKSONVILLE, FL 32216-6282
(904) 683-3205
Mailing address
6817 SOUTHPOINT PKWY, JACKSONVILLE, FL 32216-6282
(904) 683-3205
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA51836
FL
Other
Enumeration date
11/03/2009
Last updated
01/06/2012
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