Healthcare Provider Details

I. General information

NPI: 1205514346
Provider Name (Legal Business Name): MICHAEL FOSTER JR. CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8831 CREST VIEW DR
CORONA CA
92883-9112
US

IV. Provider business mailing address

8831 CREST VIEW DR
CORONA CA
92883-9112
US

V. Phone/Fax

Practice location:
  • Phone: 760-486-7029
  • Fax:
Mailing address:
  • Phone: 760-486-7029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number92205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: