Provider Demographics
NPI:1679852990
Name:HARWOOD, CHARITY JANE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:JANE
Last Name:HARWOOD
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12625 MAPLEVIEW ST APT 16
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-2401
Mailing Address - Country:US
Mailing Address - Phone:619-933-7354
Mailing Address - Fax:
Practice Address - Street 1:1761 HOTEL CIR S # 108-109
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3318
Practice Address - Country:US
Practice Address - Phone:619-298-7268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAMTC #2260174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist