MEDICARE: LESLIE GILBERT/ GIL RUTHERFORD

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	3861	CA

General Provider Information

NPI Number	:	1871223651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE GILBERT/ GIL RUTHERFORD

Provider Business Mailing Address
First Line	:	PO BOX 793
Second Line	:
City	:	PAUMA VALLEY
State	:	CA
Zip	:	92061-0793
Country	:	US
Telephone Number	:	415-250-3730
Fax Number	:

Provider Business Practice Location Address
First Line	:	32334 RINCON RANCHO RD
Second Line	:
City	:	PAUMA VALLEY
State	:	CA
Zip	:	92061-9607
Country	:	US
Telephone Number	:	415-250-3730
Fax Number	:

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

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	06/14/2022

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Directions to “ LESLIE GILBERT/ GIL RUTHERFORD ” Practice Location

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