Provider Demographics
NPI:1043894314
Name:ALANIS, ANGELIQUE RUFINA
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:RUFINA
Last Name:ALANIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 EZIE ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-2409
Mailing Address - Country:US
Mailing Address - Phone:408-569-9357
Mailing Address - Fax:
Practice Address - Street 1:387 EZIE ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-2409
Practice Address - Country:US
Practice Address - Phone:408-569-9357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69712225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist