Provider Demographics
NPI:1548652050
Name:GELLER, MAYETTE SERRANO (CMT)
Entity type:Individual
Prefix:
First Name:MAYETTE
Middle Name:SERRANO
Last Name:GELLER
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 1:31045 TEMECULA PKWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-3085
Mailing Address - Country:US
Mailing Address - Phone:951-553-3923
Mailing Address - Fax:
Practice Address - Street 1:31045 TEMECULA PKWY
Practice Address - Street 2:SUITE 203
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-3085
Practice Address - Country:US
Practice Address - Phone:951-553-3923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-21
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51641225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist