Provider Demographics
NPI:1760529242
Name:FRITSCHY, JENNIFER LYN (LAC,)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYN
Last Name:FRITSCHY
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 1:135 LIVERPOOL DR STE B
Mailing Address - Street 2:
Mailing Address - City:CARDIFF BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1843
Mailing Address - Country:US
Mailing Address - Phone:760-753-2157
Mailing Address - Fax:760-753-8108
Practice Address - Street 1:135 LIVERPOOL DR STE B
Practice Address - Street 2:
Practice Address - City:CARDIFF BY THE SEA
Practice Address - State:CA
Practice Address - Zip Code:92007-1843
Practice Address - Country:US
Practice Address - Phone:760-753-2157
Practice Address - Fax:760-753-8108
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10676171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist