Provider Demographics
NPI:1699127514
Name:JANCIC, JILL VAIL (LAC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:VAIL
Last Name:JANCIC
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17666 MONTERO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2369
Mailing Address - Country:US
Mailing Address - Phone:760-473-5351
Mailing Address - Fax:
Practice Address - Street 1:17666 MONTERO RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2369
Practice Address - Country:US
Practice Address - Phone:760-473-5351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-02
Last Update Date:2016-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 17011171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist