Most Relevant Information
Provider Data
| NPI Number: | 1003581497 |
| Provider Name: | LARA NICOLE BERTHIAUME MASSAGE THERAPIST |
| Entity Type: | Individual |
| Taxonomy Code: | 225700000X |
| Specialty: | Massage Therapist |
| License Number: | 26275 |
Most Important Dates
| Enumeration Date: | 08/09/2021 |
| Last Updated: | 08/09/2021 |
Provider Practice Location
126 STILLINGS AVE
SAN FRANCISCO
CA
941312824
Practice Location Phone/Fax
| Phone: | 8312461367 |
| Fax: |
Provider Mailing Location
126 STILLINGS AVE
SAN FRANCISCO
CA
941312824
Provider Mailing Phone/Fax
| Phone: | 8312461367 |
| Fax: |