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General NPI Number Information
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NPI Number | 1063298867
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Entity Type | Individual
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Provider Name | MATTHEW MUN TAY CMT
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Gender | Male
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Dates
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Enumeration Date | 09/06/2023
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 4455 TWAIN AVE STE H1
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City | SAN DIEGO
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State | CA
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Zip | 92120-3464
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Country | US
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Telephone | 619-693-8559
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Fax |
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Provider Business Mailing Address
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Address Line | 7356 PARKWAY DR APT 303
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City | LA MESA
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State | CA
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Zip | 91942-1842
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Country | US
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Telephone | 626-274-1310
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 68916
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License Number State | CA
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