Provider Demographics
NPI:1558505404
Name:COUTURE FITNESS
Entity type:Organization
Organization Name:COUTURE FITNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARBATEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:DE LA CUESTA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:916-744-1090
Mailing Address - Street 1:5120 J ST STE E
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3840
Mailing Address - Country:US
Mailing Address - Phone:916-744-1090
Mailing Address - Fax:916-452-2880
Practice Address - Street 1:5120 J ST STE E
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3840
Practice Address - Country:US
Practice Address - Phone:916-744-1090
Practice Address - Fax:916-452-2880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation