Provider Demographics
NPI:1922744648
Name:SILVA, JEANETTE H
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:H
Last Name:SILVA
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 1:10328 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-5914
Mailing Address - Country:US
Mailing Address - Phone:415-666-6263
Mailing Address - Fax:
Practice Address - Street 1:10328 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-5914
Practice Address - Country:US
Practice Address - Phone:415-666-6263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66235225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA66235OtherCALIFORNIA MASSAGE THERAPY COUNCIL