MEDICARE: ROBERTA LYNNE IRWIN CMT, HHP

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

General Provider Information

NPI Number	:	1922334549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA LYNNE IRWIN CMT, HHP

Provider Business Mailing Address
First Line	:	4375 NARRAGANSETT AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-2937
Country	:	US
Telephone Number	:	619-246-1561
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 CAMINO DEL RIO S
Second Line	:	SUITE 100
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3713
Country	:	US
Telephone Number	:	619-246-1561
Fax Number	:

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

Provider Enumeration Date	:	11/02/2009
Last Update Date	:	11/02/2009

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