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General NPI Number Information
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NPI Number | 1336441302
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Entity Type | Organization
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Legal Business Name | HUM SPA
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Dates
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Enumeration Date | 11/24/2010
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Last Update Date | 11/24/2010
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Provider Practice Location Address
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Address Line | 1585 HEARTWOOD DR SUITE J
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City | MCKINLEYVILLE
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State | CA
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Zip | 95519-3991
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Country | US
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Telephone | 707-839-7727
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2835
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City | MCKINLEYVILLE
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State | CA
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Zip | 95519-2835
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Country | US
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Telephone | 707-839-7727
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Fax |
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Authorized Official
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Title or Position | OWNER/CMT/ESTHETICIAN
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Name | CASSIE LEONHARDT
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Credential |
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Telephone | 707-839-7727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 000000
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License Number State | CA
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