Individual
JESSICA BROOKE TAVISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3811 MARQUETTE PL APT 4X, SAN DIEGO, CA 92106-1073
(480) 696-0291
Mailing address
3811 MARQUETTE PL APT 4X, SAN DIEGO, CA 92106-1073
(480) 696-0291
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
83837
CA
Other
Enumeration date
09/25/2020
Last updated
09/25/2020
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