Healthcare Provider Details

I. General information

NPI: 1184117384
Provider Name (Legal Business Name): JULIAN RHODES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2433 MARINER SQUARE LOOP STE 105
ALAMEDA CA
94501-1036
US

IV. Provider business mailing address

2020 55TH AVE
OAKLAND CA
94621-4356
US

V. Phone/Fax

Practice location:
  • Phone: 612-559-4863
  • Fax:
Mailing address:
  • Phone: 612-559-4863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number66679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: