Healthcare Provider Details

I. General information

NPI: 1285550939
Provider Name (Legal Business Name): FELICIA 916 230 1960 BLUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 COTTAGE WAY STE 11
SACRAMENTO CA
95825-1222
US

IV. Provider business mailing address

2717 COTTAGE WAY STE 11
SACRAMENTO CA
95825-1222
US

V. Phone/Fax

Practice location:
  • Phone: 916-230-1960
  • Fax:
Mailing address:
  • Phone: 916-230-1960
  • 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: