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General NPI Number Information
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NPI Number | 1598133555
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Entity Type | Organization
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Legal Business Name | IN ESSENCE DAY SPA, LLC
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Dates
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Enumeration Date | 09/08/2015
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Last Update Date | 09/08/2015
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Provider Practice Location Address
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Address Line | 23162 LOS ALISOS BLVD STE 102B
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City | MISSION VIEJO
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State | CA
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Zip | 92691-7861
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Country | US
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Telephone | 949-322-7981
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Fax |
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Provider Business Mailing Address
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Address Line | 23162 LOS ALISOS BLVD STE 102B
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City | MISSION VIEJO
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State | CA
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Zip | 92691-7861
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Country | US
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Telephone | 949-322-7981
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | LILIANE ZACCHARIAS
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Credential | M.T
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Telephone | 949-322-7981
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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 | 4443
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License Number State | CA
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