Provider Demographics
NPI:1962024950
Name:VOLZ, JACQUELINE K (CTRS)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:K
Last Name:VOLZ
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5702 ELINORA LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4529
Mailing Address - Country:US
Mailing Address - Phone:562-858-4675
Mailing Address - Fax:
Practice Address - Street 1:21732 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2179
Practice Address - Country:US
Practice Address - Phone:213-663-6746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59977225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist