Provider Demographics
NPI:1194335786
Name:TAPIA-CARRILLO, ROSA EVELIA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:EVELIA
Last Name:TAPIA-CARRILLO
Suffix:
Gender:F
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 1:8721 IMPERIAL HWY APT 108
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-3978
Mailing Address - Country:US
Mailing Address - Phone:323-649-0934
Mailing Address - Fax:
Practice Address - Street 1:8721 IMPERIAL HWY APT 108
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3978
Practice Address - Country:US
Practice Address - Phone:323-649-0934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46681225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46681OtherCAMTC