1912376328 NPI number — PACIFIC CREST MASSAGE AND WELLNESS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912376328 NPI number — PACIFIC CREST MASSAGE AND WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC CREST MASSAGE AND WELLNESS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912376328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7610 NE 34TH AVE
Provider Second Line Business Mailing Address:
8
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98665-0706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-787-3904
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5115 NE 94TH AVE
Provider Second Line Business Practice Location Address:
D
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98662-6180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-787-3904
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2015

Additional Information

Authorized Official

Authorized Official Last Name:
VIOLA
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSED MASSAGE PRACTITIONER
Authorized Official Telephone Number:
360-787-3904

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  60415173 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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