Provider Demographics
NPI:1932539962
Name:DWYER URIBE, NICOLE P (CMT)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:P
Last Name:DWYER URIBE
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 1:152 LUCKY ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4122
Mailing Address - Country:US
Mailing Address - Phone:415-871-6062
Mailing Address - Fax:
Practice Address - Street 1:152 LUCKY ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4122
Practice Address - Country:US
Practice Address - Phone:415-871-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist