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General NPI Number Information
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NPI Number | 1811272081
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Entity Type | Individual
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Provider Name | BIANCA XENIA CORONA LMT, CMMP
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Gender | Female
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 8004 ABBEVILLE AVE
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City | LUBBOCK
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State | TX
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Zip | 79424-2806
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Country | US
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Telephone | 806-252-1355
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Fax |
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Provider Business Mailing Address
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Address Line | 3626 59TH ST
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City | LUBBOCK
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State | TX
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Zip | 79413-4750
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Country | US
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Telephone | 806-252-1355
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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 | MT112364
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License Number State | TX
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