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Individual

MISS LACEY LAVERNE FARAH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ANMT

Contact information

Practice address
400 SUMMIT DR, PINOLE, CA 94564-1625
(707) 703-0997
Mailing address
400 SUMMIT DR, PINOLE, CA 94564-1625
(707) 703-0997

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
43394
CA

Other

Enumeration date
09/28/2020
Last updated
09/24/2024
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