Healthcare Provider Details

I. General information

NPI: 1023619079
Provider Name (Legal Business Name): REANNA WHITNALL CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9950 CAMPO RD STE 204
SPRING VALLEY CA
91977-1629
US

IV. Provider business mailing address

3629 AVOCADO VILLAGE CT UNIT 138
LA MESA CA
91941-8322
US

V. Phone/Fax

Practice location:
  • Phone: 619-647-5471
  • Fax:
Mailing address:
  • Phone: 619-647-5471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: