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Individual

PETCHARIN MATHISON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
5956 E LOS ANGELES AVE STE 4, SIMI VALLEY, CA 93063-4369
(805) 522-5552
Mailing address
5956 E LOS ANGELES AVE STE 4, SIMI VALLEY, CA 93063-4369
(805) 522-5552

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
45575
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
45575
MASSAGE PRACTITIONER
CA
Enumeration date
08/07/2013
Last updated
08/07/2013
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