=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013898832
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KUMAR SANKARA LLOYD CAMTC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2025
-----------------------------------------------------
Last Update Date | 09/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18049 COMSTOCK AVE
-----------------------------------------------------
City | SONOMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95476-4259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-669-6736
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18049 COMSTOCK AVE
-----------------------------------------------------
City | SONOMA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95476-4259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-669-6736
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 47201
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------