Healthcare Provider Details

I. General information

NPI: 1932003563
Provider Name (Legal Business Name): MS. LATRICE NICOLE MCNEALY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 INNES AVE APT 111
SAN FRANCISCO CA
94124-2912
US

IV. Provider business mailing address

145 TAYLOR ST APT 206
SAN FRANCISCO CA
94102-2875
US

V. Phone/Fax

Practice location:
  • Phone: 415-939-5656
  • Fax:
Mailing address:
  • Phone: 415-939-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: