Provider Demographics
NPI:1477762045
Name:KRIEGER, JESSICA HEATHER
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:HEATHER
Last Name:KRIEGER
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 1:404 E BIRCH ST APT 10
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5547
Mailing Address - Country:US
Mailing Address - Phone:562-841-4312
Mailing Address - Fax:
Practice Address - Street 1:404 E BIRCH ST APT 10
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5547
Practice Address - Country:US
Practice Address - Phone:562-841-4312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA 597247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other