Individual
JACQUELINE CIVIDANES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
467 FRANKLIN ST, ATHLETICS DEPARTMENT, BLOOMFIELD, NJ 07003-3425
(973) 748-9000
Mailing address
467 FRANKLIN ST, ATHLETICS DEPARTMENT, BLOOMFIELD, NJ 07003-3425
(973) 748-9000
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00192200
NJ
Other
Enumeration date
08/24/2014
Last updated
08/24/2014
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