Healthcare Provider Details

I. General information

NPI: 1730707126
Provider Name (Legal Business Name): USA THAI MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2020
Last Update Date: 07/11/2020
Certification Date: 07/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23334 VALENCIA BLVD
SANTA CLARITA CA
91355-1712
US

IV. Provider business mailing address

23334 VALENCIA BLVD
SANTA CLARITA CA
91355-1712
US

V. Phone/Fax

Practice location:
  • Phone: 661-568-9111
  • Fax:
Mailing address:
  • Phone: 661-568-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RUJIREG SRISILTANANON
Title or Position: OWNER
Credential:
Phone: 818-442-1435