MEDICARE: PRANOM NIKKI HORKAEW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	86671	CA

General Provider Information

NPI Number	:	1033863378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRANOM NIKKI HORKAEW

Provider Business Mailing Address
First Line	:	4519 E HOLLAND AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-2713
Country	:	US
Telephone Number	:	559-554-8094
Fax Number	:

Provider Business Practice Location Address
First Line	:	5649 N PALM AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-1851
Country	:	US
Telephone Number	:	559-227-1777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	02/07/2022

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