Provider Demographics
NPI:1083263537
Name:GLOVER, JESSICA CASAGRANDE (RDH)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CASAGRANDE
Last Name:GLOVER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7031 LOS VIENTOS SERENOS
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-5911
Mailing Address - Country:US
Mailing Address - Phone:805-448-2775
Mailing Address - Fax:
Practice Address - Street 1:7031 LOS VIENTOS SERENOS
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-5911
Practice Address - Country:US
Practice Address - Phone:805-448-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-07
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty