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General NPI Number Information
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NPI Number | 1922823608
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Entity Type | Organization
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Legal Business Name | INCIPE LLC
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 74140 EL PASEO
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City | PALM DESERT
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State | CA
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Zip | 92260-4147
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Country | US
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Telephone | 808-269-0927
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Fax |
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Provider Business Mailing Address
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Address Line | 62821 KITETAIL DR
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City | DESERT HOT SPRINGS
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State | CA
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Zip | 92240-2052
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Country | US
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Telephone | 808-269-0927
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSE GONZALEZ
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Credential | CMT/LMT, CPT
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Telephone | 808-269-0927
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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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