Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 69347 | CA |
NPI | 1013660489 |
---|---|
Provider Name | Li Chen |
First Address | Castro Valley, CA 94546-2946 |
Second Address | Castro Valley, CA 94546-2946 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2022 |
Last Update Date | 27/01/2022 |