Provider Demographics
NPI:1811711104
Name:THOMAS, JESSICA (CHC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22634 CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-7943
Mailing Address - Country:US
Mailing Address - Phone:951-723-0433
Mailing Address - Fax:
Practice Address - Street 1:22634 CASCADE DR
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-7943
Practice Address - Country:US
Practice Address - Phone:951-723-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education