Individual
JESSICA ELLEN BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, NC
Contact information
Practice address
1239 LIBERTY ST APT 225, EL CERRITO, CA 94530-2347
(510) 705-2680
Mailing address
1239 LIBERTY ST APT 225, EL CERRITO, CA 94530-2347
(510) 705-2680
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
Other
Enumeration date
09/22/2020
Last updated
09/22/2020
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