Provider Demographics
NPI:1043034705
Name:NORIEGA, PRISCILLA SALAS (CMT, BCTMB)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:SALAS
Last Name:NORIEGA
Suffix:
Gender:F
Credentials:CMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 N SPURGEON ST APT C
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2444
Mailing Address - Country:US
Mailing Address - Phone:303-828-7950
Mailing Address - Fax:
Practice Address - Street 1:763 S MAIN ST STE 141
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4610
Practice Address - Country:US
Practice Address - Phone:657-205-8381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68852225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist