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General NPI Number Information
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NPI Number | 1477304434
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Entity Type | Organization
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Legal Business Name | MIRAI MEDICAL MASSAGE SPA
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 1695 S SAN JACINTO AVE STE J
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City | SAN JACINTO
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State | CA
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Zip | 92583-5103
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Country | US
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Telephone | 760-825-8182
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Fax |
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Provider Business Mailing Address
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Address Line | 1695 S SAN JACINTO AVE STE J
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City | SAN JACINTO
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State | CA
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Zip | 92583-5103
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Country | US
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Telephone | 760-825-8182
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. OXANA OGIWARA
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Credential | MASSAGE THERAPIST
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Telephone | 760-825-8182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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