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General NPI Number Information
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NPI Number | 1306412465
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Entity Type | Individual
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Provider Name | MICHAEL TEJADA CMT
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Gender | Male
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Dates
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Enumeration Date | 05/31/2021
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Last Update Date | 05/31/2021
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Provider Practice Location Address
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Address Line | 10601 CHURCH ST STE 109
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-6894
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Country | US
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Telephone | 909-285-4561
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Fax |
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Provider Business Mailing Address
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Address Line | 328 E J ST
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City | ONTARIO
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State | CA
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Zip | 91764-2719
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Country | US
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Telephone | 909-238-5152
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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 | 85012
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License Number State | CA
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