Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 42975 | CA |
NPI | 1013678721 |
---|---|
Provider Name | Leeanne Michelle Bargas |
First Address | Rio Linda, CA 95673-3218 |
Second Address | Rio Linda, CA 95673-3218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2022 |
Last Update Date | 05/01/2022 |