Healthcare Provider Details

I. General information

NPI: 1396369393
Provider Name (Legal Business Name): CRISTINA MIU MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 NE 72ND DR STE 15
VANCOUVER WA
98661-7300
US

IV. Provider business mailing address

11407 NE 47TH CT
VANCOUVER WA
98686-5969
US

V. Phone/Fax

Practice location:
  • Phone: 360-326-2363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: