Healthcare Provider Details

I. General information

NPI: 1063028603
Provider Name (Legal Business Name): KELLEY ELIZABETH HUGHES MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23123 BOUQUET CYN RD 203
SANTA CLARITA CA
91350-9135
US

IV. Provider business mailing address

26123 BOUQUET CANYON RD APT 203
SANTA CLARITA CA
91350-2918
US

V. Phone/Fax

Practice location:
  • Phone: 949-244-9467
  • Fax:
Mailing address:
  • Phone: 949-244-9467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number80422
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number80422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: