Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 60293770 | WA |
NPI | 1013255330 |
---|---|
Provider Name | Mr. Carlos Anibal Lopez El Mankabadi |
First Address | Vancouver, WA 98660-2452 |
Second Address | Vancouver, WA 98663-3369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2013 |
Last Update Date | 21/01/2013 |