Provider Demographics
NPI:1497465546
Name:LEROUX, MARCEL (CMT)
Entity Type:Individual
Prefix:MR
First Name:MARCEL
Middle Name:
Last Name:LEROUX
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26739 OPALESCENT DRIVE
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584
Mailing Address - Country:US
Mailing Address - Phone:415-971-3380
Mailing Address - Fax:
Practice Address - Street 1:40516 MURRIETA HOT SPRING RD. BUILDING B, STUDIO 12
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563
Practice Address - Country:US
Practice Address - Phone:415-971-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20759OtherCERTIFIED MASSAGE THERAPIST