Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 16885 | CA |
NPI | 1003412792 |
---|---|
Provider Name | Ms. Kiera Dawn Shepherd |
First Address | San Pedro, CA 90731-6399 |
Second Address | San Pedro, CA 90731-6399 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2020 |
Last Update Date | 08/12/2020 |