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General NPI Number Information
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NPI Number | 1699145995
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Entity Type | Individual
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Provider Name | CASSANDRA CHURCH
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Gender | Female
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 23162 LOS ALISOS BLVD STE#1028
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City | MISSION VIEJO
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State | CA
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Zip | 92691-2843
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Country | US
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Telephone | 949-951-1560
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Fax |
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Provider Business Mailing Address
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Address Line | 25885 TRABUCO RD APT 55
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City | LAKE FOREST
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State | CA
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Zip | 92630-6613
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Country | US
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Telephone | 714-399-8763
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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 | 2805
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License Number State | CA
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