Provider Demographics
NPI:1093554404
Name:CARMONA, RICARDO JR (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:
Last Name:CARMONA
Suffix:JR
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5729 VINELAND AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2043
Mailing Address - Country:US
Mailing Address - Phone:818-447-5174
Mailing Address - Fax:
Practice Address - Street 1:5729 VINELAND AVE APT 8
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2043
Practice Address - Country:US
Practice Address - Phone:818-447-5174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13715225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty