JESSICA LAUREN DIVINE

SANTA CRUZ, CA
NPI1184065930
Former NameJESSICA LAUREN WALL
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: CA  145258)
Additional Taxonomies207Q00000X Family Medicine
(Licence: VA  0116026459)
Enumeration Date2013-07-09
Last Update Date2024-07-25
Business Address
Dr. JESSICA LAUREN DIVINE M.D.
1080 EMELINE AVE
SANTA CRUZ, CA 95060-1966
Phone number: 831-454-4100
Mailing Address
Dr. JESSICA LAUREN DIVINE M.D.
1080 EMELINE AVE
SANTA CRUZ, CA 95060-1966
Phone number: 831-454-4100