Individual
BRANDON LEATHERWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MT
Contact information
Practice address
30100 TOWN CENTER DR STE YZ, LAGUNA NIGUEL, CA 92677-2064
(949) 276-5401
Mailing address
30100 TOWN CENTER DR STE YZ, LAGUNA NIGUEL, CA 92677-2064
(949) 276-5401
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
61035
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61035
CERTIFIED MASSAGE THERAPIST
CA
Enumeration date
08/08/2018
Last updated
08/08/2018
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