Individual
VLADIMIR IVANOVICH CERNOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MASSAGE PRACTITIONER
Contact information
Practice address
3815 N PEARL ST, NONE, TACOMA, WA 98407-2619
(253) 761-8053
Mailing address
3815 N PEARL ST, NONE, TACOMA, WA 98407-2619
(253) 761-8053
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA 00025393
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0252162
DEPARTMENT OF LABOR AND INDUSTRIES
WA
Enumeration date
11/02/2010
Last updated
11/02/2010
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