Healthcare Provider Details

I. General information

NPI: 1235255779
Provider Name (Legal Business Name): ANGELA LAPORTA CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3483 GOLDEN GATE WAY STE 204A
LAFAYETTE CA
94549-4446
US

IV. Provider business mailing address

190 OAK CREEK CT
PLEASANT HILL CA
94523-5212
US

V. Phone/Fax

Practice location:
  • Phone: 925-284-3456
  • Fax:
Mailing address:
  • Phone: 925-674-9854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: