Provider Demographics
NPI:1033969480
Name:MINOLI, LUCA C (CMT, ANMT)
Entity Type:Individual
Prefix:
First Name:LUCA
Middle Name:C
Last Name:MINOLI
Suffix:
Gender:M
Credentials:CMT, ANMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 VIA DE LA LUZ
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6929
Mailing Address - Country:US
Mailing Address - Phone:617-645-6745
Mailing Address - Fax:
Practice Address - Street 1:530 E LOS ANGELES AVE STE 210
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2089
Practice Address - Country:US
Practice Address - Phone:818-447-3365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91186225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist