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General NPI Number Information
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NPI Number | 1871300095
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Entity Type | Individual
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Provider Name | RENA NARISU
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Gender | Female
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 4811 E GRANT RD
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City | TUCSON
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State | AZ
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Zip | 85712-2771
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Country | US
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Telephone | 520-661-8909
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Fax |
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Provider Business Mailing Address
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Address Line | 7219 W KIWI LN
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City | TUCSON
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State | AZ
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Zip | 85743-8938
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Country | US
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Telephone | 626-417-9286
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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 | 30011
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License Number State | AZ
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