Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT200635 | CA |
NPI | 1003364647 |
---|---|
Provider Name | Tanja Jones |
First Address | Olivehurst, CA 95961-9318 |
Second Address | Yuba City, CA 95993-8986 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2016 |
Last Update Date | 12/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LICENSE | MT200635 (01) | CA |