Provider Demographics
NPI:1194477984
Name:TERENTYEVA, ANASTASIYA (MS, LMT, CMT, HHPC)
Entity type:Individual
Prefix:PROF
First Name:ANASTASIYA
Middle Name:
Last Name:TERENTYEVA
Suffix:
Gender:F
Credentials:MS, LMT, CMT, HHPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82165 DOCTOR CARREON BLVD APT 3D1
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5878
Mailing Address - Country:US
Mailing Address - Phone:917-544-4302
Mailing Address - Fax:
Practice Address - Street 1:82165 DOCTOR CARREON BLVD APT 3D1
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5878
Practice Address - Country:US
Practice Address - Phone:917-544-4302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-22
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171400000X, 174H00000X, 251V00000X
CA93367225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No174H00000XOther Service ProvidersHealth Educator
No251V00000XAgenciesVoluntary or Charitable