Provider Demographics
NPI:1013300920
Name:ZOFCIK, MIROSLAV (LICENCE MASSAGE THER)
Entity Type:Individual
Prefix:MR
First Name:MIROSLAV
Middle Name:
Last Name:ZOFCIK
Suffix:
Gender:M
Credentials:LICENCE MASSAGE THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2753 HERMOSA AVE C
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020
Mailing Address - Country:US
Mailing Address - Phone:818-406-6863
Mailing Address - Fax:
Practice Address - Street 1:2331 HONOLULU AVE #E
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020
Practice Address - Country:US
Practice Address - Phone:818-406-6863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CMRC1309980225700000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist