Healthcare Provider Details

I. General information

NPI: 1962689166
Provider Name (Legal Business Name): CAROLINA NIMMER CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SALVIO ST # 26B
CONCORD CA
94520-2495
US

IV. Provider business mailing address

1621 WALTHAM RD
CONCORD CA
94520-3417
US

V. Phone/Fax

Practice location:
  • Phone: 925-457-4493
  • Fax:
Mailing address:
  • Phone: 925-457-4493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: