Individual
STACI BOKANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CMT
Contact information
Practice address
6177 RIVER CREST DR STE A, RIVERSIDE, CA 92507-0728
(951) 653-4480
Mailing address
6177 RIVER CREST DR STE A, RIVERSIDE, CA 92507-0728
(951) 653-4480
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
30018
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300188
MASSAGE THERAPY
CA
Enumeration date
06/04/2020
Last updated
06/04/2020
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