Provider Demographics
NPI:1164982831
Name:CLINICAL MASSAGE CALIFORNIA INC
Entity Type:Organization
Organization Name:CLINICAL MASSAGE CALIFORNIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:ARLEEN
Authorized Official - Last Name:PAGETT
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:916-259-2510
Mailing Address - Street 1:5714 LONETREE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-3734
Mailing Address - Country:US
Mailing Address - Phone:916-259-2510
Mailing Address - Fax:916-259-2511
Practice Address - Street 1:5714 LONETREE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-3734
Practice Address - Country:US
Practice Address - Phone:916-259-2510
Practice Address - Fax:916-259-2511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801161997Medicaid