Provider Demographics
NPI:1033660790
Name:MIRACLE MASSAGE DAY SPA
Entity Type:Organization
Organization Name:MIRACLE MASSAGE DAY SPA
Other - Org Name:NATHALY SOTO GONZALEZ
Other - Org Type:Other Name
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NATHALY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:702-756-5356
Mailing Address - Street 1:3300 E WEBB AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7288
Mailing Address - Country:US
Mailing Address - Phone:702-756-5356
Mailing Address - Fax:
Practice Address - Street 1:3415 W CRAIG RD
Practice Address - Street 2:SUTE 209
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5110
Practice Address - Country:US
Practice Address - Phone:702-636-8598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIRACLE MASSAGE DAY SPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT6638225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty