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General NPI Number Information
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NPI Number | 1073297263
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Entity Type | Individual
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Provider Name | SONIA S LUIS
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Gender | Female
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Dates
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Enumeration Date | 06/09/2023
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 1184 BROADWAY AVE
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City | ATWATER
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State | CA
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Zip | 95301-4327
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Country | US
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Telephone | 209-285-7191
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Fax |
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Provider Business Mailing Address
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Address Line | 257 3RD AVE
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City | GUSTINE
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State | CA
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Zip | 95322-1207
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Country | US
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Telephone | 209-947-8399
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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 | 75528
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License Number State | CA
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