Individual
NICHOLAS WINTER ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MASSAGE THERAPIST
Contact information
Practice address
249 CALLE VILLARIO, SAN CLEMENTE, CA 92672-2130
(949) 464-7715
Mailing address
249 CALLE VILLARIO, SAN CLEMENTE, CA 92672-2130
(949) 464-7715
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
91023
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
91023
CALIFORNIA MASSAGE THERAPY COUNCIL CERTIFICATION
CA
Enumeration date
07/27/2022
Last updated
07/27/2022
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