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General NPI Number Information
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NPI Number | 1427972165
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Entity Type | Organization
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Legal Business Name | WANNASPA BY WANNAPA LLC.
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Dates
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Enumeration Date | 08/06/2026
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Last Update Date | 08/06/2026
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Provider Practice Location Address
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Address Line | 900 LANE AVE STE 128
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City | CHULA VISTA
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State | CA
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Zip | 91914-4514
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Country | US
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Telephone | 619-304-5040
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Fax |
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Provider Business Mailing Address
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Address Line | 2303 CABO BAHIA
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City | CHULA VISTA
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State | CA
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Zip | 91914-2039
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Country | US
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Telephone | 619-948-2465
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Fax |
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Authorized Official
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Title or Position | LICENSE MASSAGE THERAPIST
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Name | MRS. WANNAPA MARTINEZ
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Credential | CAMTC
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Telephone | 619-948-2465
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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 |
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License Number State |
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