Healthcare Provider Details

I. General information

NPI: 1841970597
Provider Name (Legal Business Name): LI HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 MAGNOLIA AVE STE B3
CORONA CA
92879-3119
US

IV. Provider business mailing address

720 MAGNOLIA AVE STE B3
CORONA CA
92879-3119
US

V. Phone/Fax

Practice location:
  • Phone: 951-371-8888
  • Fax: 951-666-7077
Mailing address:
  • Phone: 951-371-8888
  • Fax: 951-666-7077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number89376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: