Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00016996 | WA |
NPI | 1003025842 |
---|---|
Provider Name | James Benjamin Mendoza |
First Address | Seattle, WA 98111-4478 |
Second Address | Shoreline, WA 98155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |