Provider Demographics
NPI:1134823792
Name:GREATOREX-MALDONADO, WENDI J (MASSAGE THEAPIST)
Entity type:Individual
Prefix:
First Name:WENDI
Middle Name:J
Last Name:GREATOREX-MALDONADO
Suffix:
Gender:F
Credentials:MASSAGE THEAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9474 KEARNY VILLA RD STE 113
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4596
Mailing Address - Country:US
Mailing Address - Phone:858-578-2070
Mailing Address - Fax:858-578-2722
Practice Address - Street 1:9474 KEARNY VILLA RD STE 113
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4596
Practice Address - Country:US
Practice Address - Phone:858-578-2070
Practice Address - Fax:858-578-2722
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28220225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist