Healthcare Provider Details

I. General information

NPI: 1528510740
Provider Name (Legal Business Name): REDZA GUERRIER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 MAIN ST
HACKENSACK NJ
07601-5704
US

IV. Provider business mailing address

263 MAIN ST
HACKENSACK NJ
07601-5704
US

V. Phone/Fax

Practice location:
  • Phone: 201-343-0350
  • Fax: 201-342-4310
Mailing address:
  • Phone: 201-343-0350
  • Fax: 201-342-4310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT00551900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: