Individual
ROESHAN SHADRAVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD. DOMP. MSC. CST.
Contact information
Practice address
1505 LOMAS SANTA FE DR, SOLANA BEACH, CA 92075-2103
(760) 212-1678
Mailing address
1160 N COAST HIGHWAY 101 #232126, ENCINITAS, CA 92023
(760) 212-1678
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
—
—
225700000X
Massage Therapist
Primary
30079
CA
Other
Enumeration date
01/11/2020
Last updated
02/02/2022
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