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General NPI Number Information
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NPI Number | 1275888232
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Entity Type | Organization
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Legal Business Name | MASSAGE MUNDO
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 07/16/2012
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Provider Practice Location Address
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Address Line | 423 EASTLAKE AVE E
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City | SEATTLE
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State | WA
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Zip | 98109-5408
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Country | US
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Telephone | 206-718-1455
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Fax |
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Provider Business Mailing Address
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Address Line | 423 EASTLAKE AVE E
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City | SEATTLE
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State | WA
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Zip | 98109-5408
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Country | US
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Telephone | 206-718-1455
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST/OWNER
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Name | YVONNE GARCIA GARCIA
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Credential | LMP
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Telephone | 206-718-1455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MA60106768
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License Number State | WA
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