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General NPI Number Information
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NPI Number | 1023509015
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Entity Type | Organization
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Legal Business Name | TULA CENTER FOR BODYWORK
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 3065 PORTER ST STE 105
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City | SOQUEL
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State | CA
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Zip | 95073-2231
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Country | US
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Telephone | 831-454-8198
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Fax |
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Provider Business Mailing Address
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Address Line | 3065 PORTER ST STE 105
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City | SOQUEL
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State | CA
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Zip | 95073-2231
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Country | US
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Telephone | 831-454-8198
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DOEL JAY NEGRON
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Credential | BOARD AND STATE CERT
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Telephone | 831-234-4876
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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 | CA
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