Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 34234 | CA |
NPI | 1003179037 |
---|---|
Provider Name | Mr. David Patrick Buono JR. |
First Address | Artesia, CA 90701-3802 |
Second Address | Artesia, CA 90701-3802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2012 |
Last Update Date | 25/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34234 | CALIFORNIA STATE CERTIFIED MASSAGE THERAPIST (01) | CA |