Provider Demographics
NPI:1497459978
Name:HESLIN, LORRAINE MARY (CMT)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:MARY
Last Name:HESLIN
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 1:16380 SOLVANG AVE # 16380
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-1163
Mailing Address - Country:US
Mailing Address - Phone:909-712-8046
Mailing Address - Fax:
Practice Address - Street 1:12555 MARIPOSA RD STE J
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-6010
Practice Address - Country:US
Practice Address - Phone:909-638-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90904225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist