Provider Demographics
NPI:1275120685
Name:MALLES, BRANDY CELESTE (CMT)
Entity Type:Individual
Prefix:MISS
First Name:BRANDY
Middle Name:CELESTE
Last Name:MALLES
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 OCEAN VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-2227
Mailing Address - Country:US
Mailing Address - Phone:831-521-7952
Mailing Address - Fax:
Practice Address - Street 1:701 OCEAN VIEW BLVD
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-2227
Practice Address - Country:US
Practice Address - Phone:831-521-7952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85594225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA85594OtherCAMTC