Provider Demographics
NPI:1982219309
Name:ROCKWELL, JESSICA (LM, CPM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ROCKWELL
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:RHOADS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5175 E PACIFIC COAST HWY STE 402
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3313
Mailing Address - Country:US
Mailing Address - Phone:562-999-2215
Mailing Address - Fax:
Practice Address - Street 1:5175 E PACIFIC COAST HWY STE 402
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3313
Practice Address - Country:US
Practice Address - Phone:562-999-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM646176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty