Healthcare Provider Details

I. General information

NPI: 1538312871
Provider Name (Legal Business Name): ASHRAF HANAFY LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 E BLITHEDALE AVE STE D
MILL VALLEY CA
94941-2000
US

IV. Provider business mailing address

203 E BLITHEDALE AVE STE D
MILL VALLEY CA
94941-2000
US

V. Phone/Fax

Practice location:
  • Phone: 415-381-1035
  • Fax: 415-381-1160
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number9100010837
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number004339
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number000464
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number00789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: