Healthcare Provider Details

I. General information

NPI: 1285103457
Provider Name (Legal Business Name): MOMENTS OF PEACE MASSAGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2018
Last Update Date: 11/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 S GREEN ST
TEHACHAPI CA
93561-1716
US

IV. Provider business mailing address

1105 ALDER AVE
TEHACHAPI CA
93561-2475
US

V. Phone/Fax

Practice location:
  • Phone: 661-527-4146
  • Fax: 661-771-3163
Mailing address:
  • Phone: 661-527-4146
  • Fax: 661-771-3163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. VINNETTE ANN DETLOFF
Title or Position: MASSAGE THERAPIST
Credential: CMT
Phone: 661-527-4146