Provider Demographics
NPI:1780499178
Name:THOMAS, JACQUE DAWN
Entity type:Individual
Prefix:
First Name:JACQUE
Middle Name:DAWN
Last Name:THOMAS
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 1:28076 FOXFIRE ST
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92586-6007
Mailing Address - Country:US
Mailing Address - Phone:760-277-7175
Mailing Address - Fax:
Practice Address - Street 1:28076 FOXFIRE ST
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-6007
Practice Address - Country:US
Practice Address - Phone:760-277-7175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach