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General NPI Number Information
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NPI Number | 1285878645
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Entity Type | Organization
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Legal Business Name | ISELLA DAY SPA LLC
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Dates
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Enumeration Date | 04/28/2009
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Last Update Date | 04/28/2009
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Provider Practice Location Address
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Address Line | 511 4TH ST
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City | BREMERTON
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State | WA
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Zip | 98337-1409
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Country | US
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Telephone | 360-377-1113
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Fax |
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Provider Business Mailing Address
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Address Line | 511 4TH ST
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City | BREMERTON
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State | WA
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Zip | 98337-1409
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Country | US
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Telephone | 360-377-1113
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARLOS JARA III
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Credential |
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Telephone | 206-235-3396
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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 | MA00024718
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60058091
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License Number State | WA
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