Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 4483 | NM |
NPI | 1013296003 |
---|---|
Provider Name | Dana Garza |
First Address | Santa Fe, NM 87502-4461 |
Second Address | Santa Fe, NM 87505-3512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2011 |
Last Update Date | 09/08/2011 |