Individual
MS. TRACI JULIA RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1316 S MEADOW LN APT 161, COLTON, CA 92324-6411
(818) 233-9708
Mailing address
1316 S MEADOW LN APT 161, COLTON, CA 92324-6411
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
12730
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12730
CERTIFIED MASSAGE THERAPIST
CA
Enumeration date
10/07/2020
Last updated
10/07/2020
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