Provider Demographics
NPI:1497347728
Name:SANKLANG, VANSIDA (CERTI MASSAGE THERAP)
Entity Type:Individual
Prefix:MRS
First Name:VANSIDA
Middle Name:
Last Name:SANKLANG
Suffix:
Gender:F
Credentials:CERTI MASSAGE THERAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 KNOLLGLEN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-7484
Mailing Address - Country:US
Mailing Address - Phone:949-656-9429
Mailing Address - Fax:
Practice Address - Street 1:56 KNOLLGLEN
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-7484
Practice Address - Country:US
Practice Address - Phone:949-656-9429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84403225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist