Provider Demographics
NPI:1255368775
Name:MOFFITT, JENNIFER MARIE (LAC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARIE
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:LAC
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Mailing Address - Street 1:2810 CAMINO DEL RIO S
Mailing Address - Street 2:#102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3818
Mailing Address - Country:US
Mailing Address - Phone:619-688-0061
Mailing Address - Fax:619-688-0026
Practice Address - Street 1:2810 CAMINO DEL RIO S
Practice Address - Street 2:#102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3818
Practice Address - Country:US
Practice Address - Phone:619-688-0061
Practice Address - Fax:619-688-0026
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAAC 8951171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist