Provider Demographics
NPI:1922821321
Name:MOLDING MASSAGE BY DORA
Entity type:Organization
Organization Name:MOLDING MASSAGE BY DORA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORA
Authorized Official - Middle Name:SILVIA
Authorized Official - Last Name:TASCON
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:361-779-7086
Mailing Address - Street 1:5540 SARATOGA BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2953
Mailing Address - Country:US
Mailing Address - Phone:361-281-3749
Mailing Address - Fax:361-333-1542
Practice Address - Street 1:5540 SARATOGA BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2953
Practice Address - Country:US
Practice Address - Phone:361-281-3749
Practice Address - Fax:361-333-1542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty