Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 8424 | CA |
NPI | 1003435991 |
---|---|
Provider Name | Jacqueline Rangel |
First Address | Riverside, CA 92505-3675 |
Second Address | Riverside, CA 92505-3675 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2020 |
Last Update Date | 10/04/2020 |