Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 60958 | CA |
NPI | 1013311687 |
---|---|
Provider Name | Keidah Chavarria |
First Address | Inglewood, CA 90302-1556 |
Second Address | Inglewood, CA 90302-1556 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2014 |
Last Update Date | 10/10/2014 |