Healthcare Provider Details

I. General information

NPI: 1861363384
Provider Name (Legal Business Name): ANGIE DENBESTE CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 521
GLEN ELLEN CA
95442-0521
US

IV. Provider business mailing address

PO BOX 521
GLEN ELLEN CA
95442-0521
US

V. Phone/Fax

Practice location:
  • Phone: 707-495-4652
  • Fax:
Mailing address:
  • Phone: 707-495-4652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number72686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: