Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 15067 | CA |
N | 226300000X | Kinesiotherapist |
NPI | 1992118293 |
---|---|
Provider Name | Miss Laquia Monique Jenkins |
First Address | Sacramento, CA 95827-1724 |
Second Address | Sacramento, CA 95838-4412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2014 |
Last Update Date | 22/04/2020 |