Healthcare Provider Details

I. General information

NPI: 1407330723
Provider Name (Legal Business Name): SONIA RASCON MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6855 4TH ST NW STE B-2
LOS RANCHOS NM
87107-6100
US

IV. Provider business mailing address

PO BOX 27127
ALBUQUERQUE NM
87125-7127
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-2752
  • Fax:
Mailing address:
  • Phone: 505-688-8053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3863
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: