Provider Demographics
NPI:1003517830
Name:KAULU, JIZELLE JAELYNN (NMT)
Entity Type:Individual
Prefix:
First Name:JIZELLE
Middle Name:JAELYNN
Last Name:KAULU
Suffix:
Gender:F
Credentials:NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 HARKNESS AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2038
Mailing Address - Country:US
Mailing Address - Phone:310-780-4386
Mailing Address - Fax:
Practice Address - Street 1:64 HARKNESS AVE APT 6
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2038
Practice Address - Country:US
Practice Address - Phone:310-780-4386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92755225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist