Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 35078 | CA |
NPI | 1013518315 |
---|---|
Provider Name | Miss Mayulee Wilawanwelsh |
First Address | Los Angeles, CA 90057 |
Second Address | Los Angeles, CA 90057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2020 |
Last Update Date | 03/11/2020 |