Provider Demographics
NPI:1154063683
Name:DOSTER, JESSICA DENISE (LMT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:DENISE
Last Name:DOSTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4551 CALIFORNIA AVE #7
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309
Mailing Address - Country:US
Mailing Address - Phone:850-566-4205
Mailing Address - Fax:
Practice Address - Street 1:4551 CALIFORNIA AVE #7
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:850-566-4205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88761225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA88761OtherMASSAGE LICENSE NUMBER