Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60521790 | WA |
NPI | 1013574763 |
---|---|
Provider Name | Jovante A Guerra |
First Address | Puyallup, WA 98375-2231 |
Second Address | Puyallup, WA 98375-2231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2019 |
Last Update Date | 28/05/2019 |