Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 60359 | CA |
NPI | 1013410257 |
---|---|
Provider Name | April Gonzalez |
First Address | San Jose, CA 95128-4342 |
Second Address | San Jose, CA 95128-4342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2018 |
Last Update Date | 14/03/2018 |