Organization
LISA GONZALEZ
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA GONZALEZ L.M.T. (LICENSED MASSAGE THERAPIST)
(619) 807-2130
Entity
Organization
Contact information
Practice address
3446 PARK BLVD, SAN DIEGO, CA 92103-5209
(619) 807-2130
Mailing address
3446 PARK BLVD, SAN DIEGO, CA 92103-5209
(619) 807-2130
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
19498
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U2298533104
SIGNA
CA
Enumeration date
03/16/2015
Last updated
03/16/2015
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