Healthcare Provider Details

I. General information

NPI: 1548652050
Provider Name (Legal Business Name): MAYETTE SERRANO GELLER CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2015
Last Update Date: 02/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31045 TEMECULA PKWY SUITE 203
TEMECULA CA
92592-3085
US

IV. Provider business mailing address

31045 TEMECULA PKWY SUITE 203
TEMECULA CA
92592-3085
US

V. Phone/Fax

Practice location:
  • Phone: 951-553-3923
  • Fax:
Mailing address:
  • Phone: 951-553-3923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number51641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: