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General NPI Number Information
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NPI Number | 1487268207
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Entity Type | Individual
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Provider Name | CAMILA PAULA CASANOVA SIWIUK TARASIUK CMT
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Gender | Female
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 03/01/2021
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Provider Practice Location Address
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Address Line | 537 MARIPOSA AVE APT 2
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94041-1728
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Country | US
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Telephone | 650-283-6084
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Fax |
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Provider Business Mailing Address
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Address Line | 1630 S DELAWARE ST UNIT 5427
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City | SAN MATEO
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State | CA
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Zip | 94402-6623
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Country | US
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Telephone | 650-283-6084
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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 | 76286
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License Number State | CA
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