Provider Demographics
NPI:1952595209
Name:DAVIES, JESSICA JACQUELINE (MTCM, LAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JACQUELINE
Last Name:DAVIES
Suffix:
Gender:F
Credentials:MTCM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-3409
Mailing Address - Country:US
Mailing Address - Phone:831-234-9198
Mailing Address - Fax:
Practice Address - Street 1:340 BRANNAN ST
Practice Address - Street 2:STE.407
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1862
Practice Address - Country:US
Practice Address - Phone:831-234-9198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10737171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist