MEDICARE: NIANE OLIVEIRA RIBEIRO DE SA

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	74725	CA

General Provider Information

NPI Number	:	1972118586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIANE OLIVEIRA RIBEIRO DE SA

Provider Business Mailing Address
First Line	:	1052 HIGH ST
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94301-2424
Country	:	US
Telephone Number	:	650-564-2429
Fax Number	:

Provider Business Practice Location Address
First Line	:	1174 LINCOLN AVE STE 5
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-3029
Country	:	US
Telephone Number	:	650-503-4737
Fax Number	:

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

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	09/10/2020

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