Provider Demographics
NPI:1992680789
Name:AQUALISS THERAPEUTIC MASSAGE & SPA
Entity type:Organization
Organization Name:AQUALISS THERAPEUTIC MASSAGE & SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JINJIN
Authorized Official - Middle Name:
Authorized Official - Last Name:QIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-395-5729
Mailing Address - Street 1:19615 LAKE BOSQUE DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-7920
Mailing Address - Country:US
Mailing Address - Phone:949-395-5729
Mailing Address - Fax:
Practice Address - Street 1:26321 NORTHWEST FWY STE 100
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5759
Practice Address - Country:US
Practice Address - Phone:832-400-5566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty