Provider Demographics
NPI:1497508360
Name:MALISSAMASSAGESLLC
Entity Type:Organization
Organization Name:MALISSAMASSAGESLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-529-5840
Mailing Address - Street 1:305 COVENTRY CIR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2792
Mailing Address - Country:US
Mailing Address - Phone:925-529-5840
Mailing Address - Fax:
Practice Address - Street 1:305 COVENTRY CIR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2792
Practice Address - Country:US
Practice Address - Phone:925-529-5840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)Group - Single Specialty