Provider Demographics
NPI:1972195246
Name:DOBIE, VISALIA COVINA
Entity Type:Individual
Prefix:MISS
First Name:VISALIA
Middle Name:COVINA
Last Name:DOBIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7336 GREENHAVEN DR APT 135
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3507
Mailing Address - Country:US
Mailing Address - Phone:916-661-1511
Mailing Address - Fax:
Practice Address - Street 1:2041 HALLMARK DR STE 2
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2212
Practice Address - Country:US
Practice Address - Phone:916-661-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SPB12021-00048225700000X
CASPB12021-00048225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA81824OtherMASSAGE THERAPY