Search › California › 363LA2100X
Jessie Wackerman
NPI 1053085076 · on the registry since 2021 · sole proprietor
Practice
- Address
- 4101 Mount Cantara Cir
Corona, CA 92882 - Phone
- (714) 267-9817
Registry record
- Primary taxonomy
- 363LA2100X
363LA2100X
- Also registered as
- 363LA2200X
363LG0600X - Licence states on file
- CA
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2021-08-03
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California