Provider Demographics
NPI:1982428017
Name:MARTIARENA, MANUEL F (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:F
Last Name:MARTIARENA
Suffix:
Gender:M
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 1:2010 CRADLE MOUNTAIN DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2178
Mailing Address - Country:US
Mailing Address - Phone:858-997-7485
Mailing Address - Fax:
Practice Address - Street 1:2010 CRADLE MOUNTAIN DR UNIT 2
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-2178
Practice Address - Country:US
Practice Address - Phone:858-997-7485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10628225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist