Individual
RACQUEL LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MT
Contact information
Practice address
653 E CAMPBELL AVE STE 5, CAMPBELL, CA 95008-2143
(408) 313-6909
Mailing address
1273 LORELEI CT, CAMPBELL, CA 95008-1716
(408) 313-6909
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
PENDING
CA
Other
Enumeration date
07/08/2010
Last updated
07/08/2010
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