Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | M51 | CA |
NPI | 1013231158 |
---|---|
Provider Name | Mr. Victor Martinez-Breners |
First Address | Fresno, CA 93711-5833 |
Second Address | Fresno, CA 93711-5833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2010 |
Last Update Date | 18/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
M51 | MASSAGE THERAPY LICENSE (01) | CA |