Healthcare Provider Details

I. General information

NPI: 1295473908
Provider Name (Legal Business Name): HILY BAKED AND RELAXED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 G ST
ANTIOCH CA
94509-1252
US

IV. Provider business mailing address

213 G ST
ANTIOCH CA
94509-1252
US

V. Phone/Fax

Practice location:
  • Phone: 925-444-5418
  • Fax:
Mailing address:
  • Phone: 925-444-5418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: TAMEKA T THOMAS
Title or Position: CEO
Credential:
Phone: 925-268-8262