Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 60719973 | WA |
NPI | 1013441963 |
---|---|
Provider Name | Jasmine Mendiola |
First Address | Lacey, WA 98516-1420 |
Second Address | Tacoma, WA 98409-2314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2017 |
Last Update Date | 18/04/2017 |