Healthcare Provider Details

I. General information

NPI: 1760796833
Provider Name (Legal Business Name): SANCTUARY MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16980 VIA TAZON STE 260
SAN DIEGO CA
92127-1658
US

IV. Provider business mailing address

8605 ARMINDA CIR UNIT 3
SANTEE CA
92071-3672
US

V. Phone/Fax

Practice location:
  • Phone: 619-456-9313
  • Fax:
Mailing address:
  • Phone: 619-756-1258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number30472
License Number StateCA

VIII. Authorized Official

Name: ABBY LACEY
Title or Position: OWNER/MASSAGE THERAPIST
Credential: CMT
Phone: 619-456-9313