Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 59699 | CA |
NPI | 1003214230 |
---|---|
Provider Name | Ms. Dessislava Issaeva |
First Address | San Francisco, CA 94115-3180 |
Second Address | San Francisco, CA 94115-3180 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2014 |
Last Update Date | 22/12/2014 |