Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 84759 | CA |
NPI | 1013509397 |
---|---|
Provider Name | Clemence Nguyen |
First Address | Los Angeles, CA 90026-4170 |
Second Address | South Pasadena, CA 91030-4561 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2021 |
Last Update Date | 08/02/2021 |