Provider Demographics
NPI:1477137073
Name:PLAKE, BEATRIZ DA SILVEIRA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:DA SILVEIRA
Last Name:PLAKE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 BONITA DR
Mailing Address - Street 2:
Mailing Address - City:S PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4316
Mailing Address - Country:US
Mailing Address - Phone:818-486-9210
Mailing Address - Fax:
Practice Address - Street 1:39 MILLS PL
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-1909
Practice Address - Country:US
Practice Address - Phone:818-486-9210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86195225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist