Healthcare Provider Details

I. General information

NPI: 1992442701
Provider Name (Legal Business Name): JINFANG ZHU BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1869 LAKE PINE DR
CARY NC
27511-6043
US

IV. Provider business mailing address

1869 LAKE PINE DR
CARY NC
27511-6043
US

V. Phone/Fax

Practice location:
  • Phone: 919-234-1208
  • Fax:
Mailing address:
  • Phone: 919-234-1208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number19824
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: