Healthcare Provider Details

I. General information

NPI: 1285475061
Provider Name (Legal Business Name): MIMOSAS N MASSAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 SUNRISE VISTA DR STE 2180
CITRUS HEIGHTS CA
95610-7057
US

IV. Provider business mailing address

6060 SUNRISE VISTA DR STE 2180
CITRUS HEIGHTS CA
95610-7057
US

V. Phone/Fax

Practice location:
  • Phone: 916-548-6018
  • Fax:
Mailing address:
  • Phone: 916-548-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: LAQUIA MONIQUE JENKINS
Title or Position: MANAGING MEMBER
Credential: CMT
Phone: 916-879-9190