Individual
BRANDIE DETAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18200 YORBA LINDA BLVD, SUITE 104, YORBA LINDA, CA 92886-4056
(714) 646-8000
(714) 572-2562
Mailing address
18200 YORBA LINDA BLVD, SUITE 401, YORBA LINDA, CA 92886-4056
(714) 646-8000
(714) 572-2562
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
1237678
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1237678
MASSAGE THERAPY ASSOCIATION LICENSE
CA
Enumeration date
01/20/2010
Last updated
01/20/2010
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