Provider Demographics
NPI:1114109493
Name:THOMPSON, JILLIAN LEIGH
Entity Type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:LEIGH
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 RUFFIN CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-5300
Mailing Address - Country:US
Mailing Address - Phone:858-514-4639
Mailing Address - Fax:858-514-4656
Practice Address - Street 1:9400 RUFFIN CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-5300
Practice Address - Country:US
Practice Address - Phone:858-514-4639
Practice Address - Fax:858-514-4656
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist