Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1013094937 |
---|---|
Provider Name | Natasha Castillo-Lopez |
First Address | Palm Desert, CA 92211-3128 |
Second Address | Palm Desert, CA 92211-3128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 15/01/2014 |