Provider Demographics
NPI:1679069629
Name:DETLOFF, VINNETTE ANN (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:VINNETTE
Middle Name:ANN
Last Name:DETLOFF
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 ALDER AVE
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-2475
Mailing Address - Country:US
Mailing Address - Phone:661-527-4146
Mailing Address - Fax:
Practice Address - Street 1:113 S GREEN ST
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-1716
Practice Address - Country:US
Practice Address - Phone:661-527-4146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74845225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist