Provider Demographics
NPI:1194328112
Name:CAMPBELL, JACQUELYN INEZ
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:INEZ
Last Name:CAMPBELL
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 1:2667 CAMINO DEL RIO S STE 106-4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3707
Mailing Address - Country:US
Mailing Address - Phone:619-736-4370
Mailing Address - Fax:
Practice Address - Street 1:2667 CAMINO DEL RIO S STE 106-4
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3707
Practice Address - Country:US
Practice Address - Phone:760-608-7067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76556225700000X
CAAC19413171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist