Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT0019130 | CO |
NPI | 1003360819 |
---|---|
Provider Name | Iliana Cruz |
First Address | Littleton, CO 80128-7406 |
Second Address | Littleton, CO 80123-9542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2016 |
Last Update Date | 09/08/2016 |