Provider Demographics
NPI:1306935374
Name:4 YOUR HEALTH MASSAGE CENTER
Entity type:Organization
Organization Name:4 YOUR HEALTH MASSAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOLISTIC HEALTH PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:T
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:HHP
Authorized Official - Phone:619-298-7268
Mailing Address - Street 1:1761 HOTEL CIR S # 108-109
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3318
Mailing Address - Country:US
Mailing Address - Phone:619-298-7268
Mailing Address - Fax:
Practice Address - Street 1:1761 HOTEL CIR S # 108-109
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3318
Practice Address - Country:US
Practice Address - Phone:619-298-7268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2003024665174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty