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General NPI Number Information
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NPI Number | 1215799366
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Entity Type | Organization
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Legal Business Name | AZALEA ZEN MASSAGE LLC
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Dates
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Enumeration Date | 01/24/2024
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 1505 WATER ST NE STE 2
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City | SALEM
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State | OR
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Zip | 97301-6467
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Country | US
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Telephone | 971-218-1694
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Fax |
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Provider Business Mailing Address
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Address Line | 1505 WATER ST NE STE 2
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City | SALEM
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State | OR
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Zip | 97301-6467
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Country | US
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Telephone | 971-218-1694
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST
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Name | MAXINE VALERIE TRUJILLO
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Credential | LMT#21038
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Telephone | 971-218-1694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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