Healthcare Provider Details

I. General information

NPI: 1427111368
Provider Name (Legal Business Name): PAULA MARIE CORDES CERTIFIED MASSAGE PR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 HWY 9 SUITE 1
FELTON CA
95018-9220
US

IV. Provider business mailing address

5533 WASHINGTON WAY
FELTON CA
95018-9220
US

V. Phone/Fax

Practice location:
  • Phone: 831-335-3303
  • Fax: 831-335-3303
Mailing address:
  • Phone: 831-335-3303
  • Fax: 831-335-3303

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: