Individual
MOON LEAF DEROSIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMT
Contact information
Practice address
5960B WEST MALL, ATASCADERO, CA 93422-4232
(415) 706-6397
Mailing address
PO BOX 4273, PASO ROBLES, CA 93447-4273
(415) 706-6397
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
10405
CA
Other
Enumeration date
07/20/2016
Last updated
07/20/2016
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