Provider Demographics
NPI:1952962078
Name:CARRANZA ISLAS, JEANETTE M
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:M
Last Name:CARRANZA ISLAS
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 1:1129 PACIFIC GROVE LOOP
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-2114
Mailing Address - Country:US
Mailing Address - Phone:619-587-2331
Mailing Address - Fax:
Practice Address - Street 1:4190 BONITA RD STE 209
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1340
Practice Address - Country:US
Practice Address - Phone:619-587-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16680171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist