Provider Demographics
NPI:1508635632
Name:ELUMBA, CATHERINE A (CMT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:ELUMBA
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 1:109 WILDBERRY CT
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8034
Mailing Address - Country:US
Mailing Address - Phone:415-309-5211
Mailing Address - Fax:
Practice Address - Street 1:390 MILITARY E UNIT B
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2811
Practice Address - Country:US
Practice Address - Phone:415-309-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4691225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist