Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | ||
Y | 225700000X | Massage Therapist | CMRC1309980 |
NPI | 1013300920 |
---|---|
Provider Name | Mr. Miroslav Zofcik |
First Address | Montrose, CA 91020 |
Second Address | Montrose, CA 91020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2015 |
Last Update Date | 17/03/2015 |