Healthcare Provider Details

I. General information

NPI: 1053256396
Provider Name (Legal Business Name): XIUHUA SUO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 E VALLEY BLVD STE 217
WEST COVINA CA
91792-3197
US

IV. Provider business mailing address

2707 E VALLEY BLVD STE 217
WEST COVINA CA
91792-3197
US

V. Phone/Fax

Practice location:
  • Phone: 626-376-4896
  • Fax: 626-604-9030
Mailing address:
  • Phone: 626-376-4896
  • Fax: 626-604-9030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number94204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: