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General NPI Number Information
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NPI Number | 1699145847
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Entity Type | Organization
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Legal Business Name | XUBA EVARISTO
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Dates
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Enumeration Date | 09/30/2015
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Last Update Date | 09/30/2015
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Provider Practice Location Address
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Address Line | 1262 OLD WILLOW LN
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City | ASHLAND
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State | OR
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Zip | 97520-1341
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Country | US
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Telephone | 541-778-0015
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Fax |
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Provider Business Mailing Address
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Address Line | 1467 SISKIYOU BLVD # 1144
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City | ASHLAND
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State | OR
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Zip | 97520-2336
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ERIC LAURION
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Credential |
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Telephone | 612-432-2934
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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 | 21073
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License Number State | OR
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