Individual
CLARISSA AURELIA GONZALEZ-WIGGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
337 OAKS TRL STE 111, GARLAND, TX 75043-4096
(310) 699-7876
Mailing address
712 MEADOWDALE DR, ROYSE CITY, TX 75189-3513
(310) 699-7876
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT102538
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT102538
MASSAGE THERAPIST
TX
Enumeration date
04/06/2012
Last updated
04/06/2012
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