Provider Demographics
NPI:1295477636
Name:SHIMABUKURO, ALMA NEREYDA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:ALMA
Middle Name:NEREYDA
Last Name:SHIMABUKURO
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E VALLEY PKWY SPC 187
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-2956
Mailing Address - Country:US
Mailing Address - Phone:619-319-7409
Mailing Address - Fax:
Practice Address - Street 1:2065 S ESCONDIDO BLVD STE 105
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-8221
Practice Address - Country:US
Practice Address - Phone:760-565-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89478225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA89478OtherMASSAGE THERAPIST