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General NPI Number Information
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NPI Number | 1851153589
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Entity Type | Organization
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Legal Business Name | INSATIABLE MASSAGE & BEAUTY SVC LLC SERVICES
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 267 N TERRACE ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92410-1429
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Country | US
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Telephone | 909-771-0751
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Fax |
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Provider Business Mailing Address
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Address Line | 30 N GOULD ST STE R
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City | SHERIDAN
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State | WY
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Zip | 82801-6317
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Country | US
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Telephone | 307-381-1922
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Fax |
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Authorized Official
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Title or Position | LICENSE MASSAGE THERAPIST
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Name | NADYA MARIE WOODS
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Credential | LMR
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Telephone | 909-771-0751
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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 |
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License Number State |
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