Provider Demographics
NPI:1285878645
Name:ISELLA DAY SPA LLC
Entity type:Organization
Organization Name:ISELLA DAY SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:JARA
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:206-235-3396
Mailing Address - Street 1:511 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-1409
Mailing Address - Country:US
Mailing Address - Phone:360-377-1113
Mailing Address - Fax:
Practice Address - Street 1:511 4TH ST
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337-1409
Practice Address - Country:US
Practice Address - Phone:360-377-1113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60058091225700000X
WAMA00024718225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty