Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 81672 | CA |
NPI | 1003491903 |
---|---|
Provider Name | Raphaelle Gruys |
First Address | Fairfield, CA 94534-1627 |
Second Address | Fairfield, CA 94534-1627 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2021 |
Last Update Date | 11/03/2021 |