Healthcare Provider Details

I. General information

NPI: 1184238156
Provider Name (Legal Business Name): GIANLUCA CIULLA CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2020
Last Update Date: 09/07/2020
Certification Date: 09/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 CEDAR ST
SANTA CRUZ CA
95060-4304
US

IV. Provider business mailing address

PO BOX 566
BOULDER CREEK CA
95006-0566
US

V. Phone/Fax

Practice location:
  • Phone: 831-458-9355
  • Fax:
Mailing address:
  • Phone: 707-601-0957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number41069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: