Provider Demographics
NPI:1023286994
Name:ELITE, JAMILAH EL (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MISS
First Name:JAMILAH
Middle Name:EL
Last Name:ELITE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:MISS
Other - First Name:JAMILAH
Other - Middle Name:ELITE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:1012 CHELSEA
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-3848
Mailing Address - Country:US
Mailing Address - Phone:510-435-7772
Mailing Address - Fax:
Practice Address - Street 1:628 2ND AVE STE 302
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:CA
Practice Address - Zip Code:94525-1176
Practice Address - Country:US
Practice Address - Phone:510-435-7772
Practice Address - Fax:510-787-7704
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175F00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No175F00000XOther Service ProvidersNaturopath