Provider Demographics
NPI:1497062731
Name:JARVIS, LISA ANN (MT/HHP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:JARVIS
Suffix:
Gender:F
Credentials:MT/HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 W SAN MARCOS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1112
Mailing Address - Country:US
Mailing Address - Phone:760-695-2578
Mailing Address - Fax:
Practice Address - Street 1:811 W SAN MARCOS BLVD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1112
Practice Address - Country:US
Practice Address - Phone:760-695-2578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist