Provider Demographics
NPI:1902576499
Name:SANZ-GOULD, NICHOLAS JULIEN (LMT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JULIEN
Last Name:SANZ-GOULD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 COLBY AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4050
Mailing Address - Country:US
Mailing Address - Phone:415-378-0788
Mailing Address - Fax:
Practice Address - Street 1:1519 9TH ST STE 103
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4600
Practice Address - Country:US
Practice Address - Phone:425-212-9129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61201055225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist