Healthcare Provider Details

I. General information

NPI: 1235058553
Provider Name (Legal Business Name): THE MASSAGE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 PARK ST UNIT D
ALAMEDA CA
94501-4509
US

IV. Provider business mailing address

1419 PARK ST UNIT D
ALAMEDA CA
94501-4509
US

V. Phone/Fax

Practice location:
  • Phone: 510-409-3596
  • Fax:
Mailing address:
  • Phone: 510-409-3596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name: BABY GIRL LEE
Title or Position: OWNER
Credential:
Phone: 510-679-9213