Healthcare Provider Details

I. General information

NPI: 1851200786
Provider Name (Legal Business Name): ANNE VAN DER WERFF MARCALO CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 N DUTTON AVE STE 120
SANTA ROSA CA
95401-4652
US

IV. Provider business mailing address

1160 N DUTTON AVE STE 120
SANTA ROSA CA
95401-4652
US

V. Phone/Fax

Practice location:
  • Phone: 707-541-6258
  • Fax: 707-284-0122
Mailing address:
  • Phone: 707-541-6258
  • Fax: 707-284-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8799
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: