Provider Demographics
NPI:1669063517
Name:MINIMOON MASSAGE STUDIO LLC
Entity type:Organization
Organization Name:MINIMOON MASSAGE STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RACQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-841-4441
Mailing Address - Street 1:1308 FERRY PL
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-1207
Mailing Address - Country:US
Mailing Address - Phone:312-841-4441
Mailing Address - Fax:
Practice Address - Street 1:530 S NORMAN C. FRANCIS PKWY
Practice Address - Street 2:MINIMOON MASSAGE STUDIO
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119
Practice Address - Country:US
Practice Address - Phone:312-841-4441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service