Healthcare Provider Details

I. General information

NPI: 1104551894
Provider Name (Legal Business Name): NAAYA KAMILLE BORDEAUX CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 12/16/2025
Certification Date: 07/18/2022
Deactivation Date: 01/07/2025
Reactivation Date: 12/16/2025

III. Provider practice location address

3444 SMOKETREE COMMONS DR APT 221
PLEASANTON CA
94566-7962
US

IV. Provider business mailing address

2208 WHITEGATE DR APT 1J
COLUMBIA MO
65202-3609
US

V. Phone/Fax

Practice location:
  • Phone: 925-699-8931
  • Fax:
Mailing address:
  • Phone: 925-699-8931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number64093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: