Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 81335 | CA |
NPI | 1013515055 |
---|---|
Provider Name | Brian Garcia |
First Address | Westminster, CA 92683-6222 |
Second Address | Stanton, CA 90680-1915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2020 |
Last Update Date | 12/10/2020 |