MEDICARE: LUCA C MINOLI CMT, ANMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	91186	CA

General Provider Information

NPI Number	:	1033969480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCA C MINOLI CMT, ANMT

Provider Business Mailing Address
First Line	:	480 VIA DE LA LUZ
Second Line	:
City	:	NEWBURY PARK
State	:	CA
Zip	:	91320-6929
Country	:	US
Telephone Number	:	617-645-6745
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 E LOS ANGELES AVE STE 210
Second Line	:
City	:	MOORPARK
State	:	CA
Zip	:	93021-2089
Country	:	US
Telephone Number	:	818-447-3365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2024
Last Update Date	:	03/26/2024

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