Healthcare Provider Details

I. General information

NPI: 1740193614
Provider Name (Legal Business Name): TINA EATON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5836 CORPORATE AVE STE 120
CYPRESS CA
90630-4751
US

IV. Provider business mailing address

5836 CORPORATE AVE STE 120
CYPRESS CA
90630-4751
US

V. Phone/Fax

Practice location:
  • Phone: 714-229-3660
  • Fax: 714-229-3663
Mailing address:
  • Phone: 714-229-3660
  • Fax: 714-229-3663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number103954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: