Individual
TANYA LISA FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
25040 STEWART ST, LOMA LINDA, CA 92350-1723
(909) 206-9191
Mailing address
P.O. BOX 1073, LOMA LINDA, CA 92354
(909) 206-9191
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
43612
CA
Other
Enumeration date
04/25/2024
Last updated
04/25/2024
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