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General NPI Number Information
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NPI Number | 1013876002
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Entity Type | Organization
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Legal Business Name | LUCKY'S BLESSED HANDS
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Dates
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Enumeration Date | 01/16/2026
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 12881 FREDERICK ST APT 108
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City | MORENO VALLEY
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State | CA
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Zip | 92553-5285
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Country | US
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Telephone | 951-867-7121
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Fax |
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Provider Business Mailing Address
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Address Line | 12625 FREDERICK ST. I5 #104
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City | MORENO VALLEY
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State | CA
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Zip | 92553
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Country | US
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Telephone | 951-867-7121
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Fax |
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Authorized Official
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Title or Position | OWNER/MASSAGE THERAPY
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Name | ANTONIO WINGSTER
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Credential |
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Telephone | 951-867-7121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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