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General NPI Number Information
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NPI Number | 1982474292
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Entity Type | Individual
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Provider Name | KRISTEN MEDINA MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 1111 S ROOP ST UNIT 2743
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City | CARSON CITY
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State | NV
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Zip | 89702-7210
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Country | US
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Telephone | 702-372-8335
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Fax |
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Provider Business Mailing Address
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Address Line | 304 S JONES BLVD # 2612
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City | LAS VEGAS
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State | NV
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Zip | 89107-2623
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Country | US
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Telephone | 702-372-8335
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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 | NVMT.12289
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License Number State | NV
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