Provider Demographics
NPI:1962867135
Name:HE, ENLAN (CMT)
Entity Type:Individual
Prefix:
First Name:ENLAN
Middle Name:
Last Name:HE
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 1:1121 WHITE ROCK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-5584
Mailing Address - Country:US
Mailing Address - Phone:916-933-5588
Mailing Address - Fax:
Practice Address - Street 1:1121 WHITE ROCK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-5584
Practice Address - Country:US
Practice Address - Phone:916-933-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60358225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist