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General NPI Number Information
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NPI Number | 1487429767
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Entity Type | Individual
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Provider Name | SUZANNE YUKIKO MATHIAS CMT
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Gender | Female
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Dates
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Enumeration Date | 11/16/2023
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 431 30TH ST STE 250C
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City | OAKLAND
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State | CA
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Zip | 94609-3307
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Country | US
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Telephone | 510-919-9904
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Fax |
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Provider Business Mailing Address
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Address Line | 931 57TH ST
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City | OAKLAND
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State | CA
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Zip | 94608-2801
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Country | US
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Telephone | 510-919-9904
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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 | 89556
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License Number State | CA
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