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General NPI Number Information
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NPI Number | 1689038135
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Entity Type | Individual
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Provider Name | ALBERT LUIS MACOUZET JR.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 1114 N COAST HWY 101, SUITE 1A
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City | ENCINITAS
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State | CA
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Zip | 92024
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Country | US
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Telephone | 858-602-2359
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Fax |
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Provider Business Mailing Address
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Address Line | 2271 VIA ESMARCA APT A
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City | OCEANSIDE
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State | CA
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Zip | 92054-7331
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Country | US
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Telephone | 858-602-2359
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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 | 26171
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License Number State | CA
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