Provider Demographics
NPI:1780948760
Name:TARTUFFE, DESTINEE (CMT)
Entity type:Individual
Prefix:
First Name:DESTINEE
Middle Name:
Last Name:TARTUFFE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-5006
Mailing Address - Country:US
Mailing Address - Phone:707-548-4882
Mailing Address - Fax:
Practice Address - Street 1:3905 MAYETTE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7226
Practice Address - Country:US
Practice Address - Phone:707-548-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist