Provider Demographics
NPI:1568895035
Name:GOLDTHORPE, JESSICA ERIN (LAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ERIN
Last Name:GOLDTHORPE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 ARAGON DR
Mailing Address - Street 2:SUITE 14
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5803
Mailing Address - Country:US
Mailing Address - Phone:520-548-5152
Mailing Address - Fax:
Practice Address - Street 1:4320 ARAGON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-5803
Practice Address - Country:US
Practice Address - Phone:520-548-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15489171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist