Provider Demographics
NPI:1467678797
Name:COLE, JESSICA MARIE (MS, TCM, LAC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MARIE
Last Name:COLE
Suffix:
Gender:F
Credentials:MS, TCM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:815 GRAND AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1209
Mailing Address - Country:US
Mailing Address - Phone:760-891-8083
Mailing Address - Fax:760-891-8093
Practice Address - Street 1:815 GRAND AVE STE 105
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1209
Practice Address - Country:US
Practice Address - Phone:760-891-8083
Practice Address - Fax:760-891-8093
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11426171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist