Healthcare Provider Details

I. General information

NPI: 1396117784
Provider Name (Legal Business Name): DAVID VERA CAMTC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 GLENWOOD RD
GLENDALE CA
91201-1812
US

IV. Provider business mailing address

4102 ORANGE AVE SUITE 106
LONG BEACH CA
90807-3072
US

V. Phone/Fax

Practice location:
  • Phone: 818-970-7317
  • Fax:
Mailing address:
  • Phone: 562-444-5098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number31027
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number31027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: