Provider Demographics
NPI:1245904523
Name:CLINKSCALE, BIANCA L
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:L
Last Name:CLINKSCALE
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 1:8583 IRVINE CENTER DR # 368
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4298
Mailing Address - Country:US
Mailing Address - Phone:657-549-1317
Mailing Address - Fax:
Practice Address - Street 1:45 W 45TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036
Practice Address - Country:US
Practice Address - Phone:657-549-1317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82442225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist