Healthcare Provider Details

I. General information

NPI: 1649777046
Provider Name (Legal Business Name): JULIA-LAUREN GARCIA-MELAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 ADDISON ST
BERKELEY CA
94710-1919
US

IV. Provider business mailing address

1052 TEVLIN ST
ALBANY CA
94706-2449
US

V. Phone/Fax

Practice location:
  • Phone: 510-566-9396
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number67409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: