Provider Demographics
NPI:1023509015
Name:TULA CENTER FOR BODYWORK
Entity type:Organization
Organization Name:TULA CENTER FOR BODYWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOEL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:NEGRON
Authorized Official - Suffix:
Authorized Official - Credentials:BOARD AND STATE CERT
Authorized Official - Phone:831-234-4876
Mailing Address - Street 1:3065 PORTER ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2231
Mailing Address - Country:US
Mailing Address - Phone:831-454-8198
Mailing Address - Fax:
Practice Address - Street 1:3065 PORTER ST STE 105
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2231
Practice Address - Country:US
Practice Address - Phone:831-454-8198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty