Healthcare Provider Details

I. General information

NPI: 1366887200
Provider Name (Legal Business Name): MISSION MASSAGE THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30048 MISSION BLVD STE 132
HAYWARD CA
94544-7254
US

IV. Provider business mailing address

30048 MISSION BLVD STE 132
HAYWARD CA
94544-7254
US

V. Phone/Fax

Practice location:
  • Phone: 510-324-4488
  • Fax:
Mailing address:
  • Phone: 510-324-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2012050001
License Number StateCA

VIII. Authorized Official

Name: RUI WANG
Title or Position: CERTIFIED MASSAGE THERAPIST/OWNER
Credential:
Phone: 510-364-4633