Provider Demographics
NPI:1316545106
Name:VALENTINE, TAMARA RANELLE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:RANELLE
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:RANELLE
Other - Middle Name:
Other - Last Name:VALENTINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:831 DARRELL ST
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3313
Mailing Address - Country:US
Mailing Address - Phone:562-726-5866
Mailing Address - Fax:
Practice Address - Street 1:831 DARRELL ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3313
Practice Address - Country:US
Practice Address - Phone:562-726-5866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82407225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist