Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 331571-00 | CA |
NPI | 1013517457 |
---|---|
Provider Name | Raman Khoshabeh |
First Address | San Diego, CA 92150-3245 |
Second Address | San Diego, CA 92128-4114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2020 |
Last Update Date | 26/10/2020 |