Provider Demographics
NPI:1366986689
Name:ZIZZO, JESSICA (CMT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ZIZZO
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 W C ST
Mailing Address - Street 2:STE 190
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3533
Mailing Address - Country:US
Mailing Address - Phone:619-232-4030
Mailing Address - Fax:
Practice Address - Street 1:444 W C ST
Practice Address - Street 2:STE 190
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3533
Practice Address - Country:US
Practice Address - Phone:619-232-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58415225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist