Provider Demographics
NPI:1699115840
Name:NUZZO, JESSICA R (E-RYT 500)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:R
Last Name:NUZZO
Suffix:
Gender:F
Credentials:E-RYT 500
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GARDENSIDE DR
Mailing Address - Street 2:#103
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-3306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 GARDENSIDE DR
Practice Address - Street 2:#103
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-3306
Practice Address - Country:US
Practice Address - Phone:917-572-8186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
37395225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner