Provider Demographics
NPI:1821719840
Name:CALIFORNIA MASSAGE
Entity Type:Organization
Organization Name:CALIFORNIA MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER/CERTIFIED MT
Authorized Official - Prefix:
Authorized Official - First Name:RISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-740-9390
Mailing Address - Street 1:2525 BROADWAY APT 22
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-2165
Mailing Address - Country:US
Mailing Address - Phone:858-740-9390
Mailing Address - Fax:
Practice Address - Street 1:3410 HIGHLAND AVE STE 21
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7420
Practice Address - Country:US
Practice Address - Phone:858-740-9390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORNIA MASSAGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA900766276Medicaid