Healthcare Provider Details

I. General information

NPI: 1407570153
Provider Name (Legal Business Name): TRACIE ANN NESTLER LMT,AAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRACIE ANN TRAVIS LMT,AAS

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1571 N MAGNOLIA AVE STE 212
EL CAJON CA
92020-1274
US

IV. Provider business mailing address

244 N MOLLISON AVE APT 101
EL CAJON CA
92021-6892
US

V. Phone/Fax

Practice location:
  • Phone: 619-975-2730
  • Fax:
Mailing address:
  • Phone: 858-899-1287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number71871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: