Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1003583618 |
---|---|
Provider Name | Deanza Dominguez |
First Address | Woodland Hills, CA 91367-2647 |
Second Address | Los Angeles, CA 90048-5223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2021 |
Last Update Date | 23/08/2021 |