MEDICARE: MIMOSAS N MASSAGE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	133N00000X	Nutritionist
2	133NN1002X	Nutrition Education Nutritionist
3	174H00000X	Health Educator
4	225700000X	Massage Therapist
5	173C00000X	Reflexologist
6	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1285475061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIMOSAS N MASSAGE, LLC

Provider Business Mailing Address
First Line	:	6060 SUNRISE VISTA DR STE 2180
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7057
Country	:	US
Telephone Number	:	279-675-4010
Fax Number	:

Provider Business Practice Location Address
First Line	:	6060 SUNRISE VISTA DR STE 2180
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7057
Country	:	US
Telephone Number	:	279-675-4010
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	LAQUIA MONIQUE JENKINS
Credential	:	CMT
Telephone Number	:	916-879-9190

Provider Enumeration Date	:	06/04/2024
Last Update Date	:	02/01/2026

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Directions to “MIMOSAS N MASSAGE, LLC ” Practice Location

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