Provider Demographics
NPI:1013148428
Name:DAYA-WASHBURN, JESSY (LAC)
Entity type:Individual
Prefix:MS
First Name:JESSY
Middle Name:
Last Name:DAYA-WASHBURN
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 1:110 OAK RIM CT APT 34
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 JACKSON ST
Practice Address - Street 2:SUITE 103B
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-7141
Practice Address - Country:US
Practice Address - Phone:408-656-9648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12889171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist