Provider Demographics
NPI:1598251159
Name:QUIROZ ZUNIGA, JESSICA LILIANA (CMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LILIANA
Last Name:QUIROZ ZUNIGA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 NE KNOTT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3108
Mailing Address - Country:US
Mailing Address - Phone:503-567-9950
Mailing Address - Fax:
Practice Address - Street 1:443 NE KNOTT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3108
Practice Address - Country:US
Practice Address - Phone:503-567-9950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75747225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
75747OtherCALIFORNIA MASSAGE THERAPY COUNCIL
OR26592OtherOREGON BOARD OF MASSAGE THERAPY