Provider Demographics
NPI:1740168806
Name:WONGRATTANAKUL, MAYSINEE
Entity type:Individual
Prefix:MISS
First Name:MAYSINEE
Middle Name:
Last Name:WONGRATTANAKUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SAN MARCO WAY
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-1149
Mailing Address - Country:US
Mailing Address - Phone:929-231-3733
Mailing Address - Fax:
Practice Address - Street 1:105 SAN MARCO WAY
Practice Address - Street 2:
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-1149
Practice Address - Country:US
Practice Address - Phone:929-231-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96086225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist