Individual
BONIFACE MWELE MBAYACHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CMT,NMT
Contact information
Practice address
7765 HEALDSBURG AVE STE 13D, SEBASTOPOL, CA 95472-3355
(707) 790-7328
Mailing address
7765 HEALDSBURG AVE STE 13D, SEBASTOPOL, CA 95472-3355
(707) 790-7328
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
78648
CA
Other
Enumeration date
11/21/2020
Last updated
11/06/2022
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