Provider Demographics
NPI:1003214230
Name:ISSAEVA, DESSISLAVA (CMT)
Entity type:Individual
Prefix:MS
First Name:DESSISLAVA
Middle Name:
Last Name:ISSAEVA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:MS
Other - First Name:DESSI
Other - Middle Name:
Other - Last Name:ISSAEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:1833 FILLMORE ST
Mailing Address - Street 2:SUITE 102-5
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3180
Mailing Address - Country:US
Mailing Address - Phone:415-868-4347
Mailing Address - Fax:
Practice Address - Street 1:1833 FILLMORE ST
Practice Address - Street 2:SUITE 102-5
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3180
Practice Address - Country:US
Practice Address - Phone:415-868-4347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59699225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist