=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124908637
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAYMOND WASHINGTON JR.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2025
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 460 CITY CENTER DR
-----------------------------------------------------
City | ROHNERT PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94928-2186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-536-7323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 BRIARWOOD CT
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95401-6011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-536-7323
-----------------------------------------------------
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 | 62619
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------