Provider Demographics
NPI:1386895977
Name:ROSE, JESSICA CURL (LAC)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:CURL
Last Name:ROSE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24800 PHILO GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ELK
Mailing Address - State:CA
Mailing Address - Zip Code:95432-9405
Mailing Address - Country:US
Mailing Address - Phone:707-877-1662
Mailing Address - Fax:
Practice Address - Street 1:24800 PHILO GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:ELK
Practice Address - State:CA
Practice Address - Zip Code:95432-9405
Practice Address - Country:US
Practice Address - Phone:707-877-1662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12682171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist