Provider Demographics
NPI:1982400966
Name:REBOYA, DOMINIQUE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:DOMINIQUE
Middle Name:
Last Name:REBOYA
Suffix:
Gender:
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 1:36421 FLOWER BASKET RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-8675
Mailing Address - Country:US
Mailing Address - Phone:951-719-6958
Mailing Address - Fax:
Practice Address - Street 1:36421 FLOWER BASKET RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-8675
Practice Address - Country:US
Practice Address - Phone:951-719-6958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95581225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist