Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | 30480 | CA |
N | 175L00000X | Homeopath | 30480 | CA |
Y | 225700000X | Massage Therapist | 30480 | CA |
NPI | 1891112959 |
---|---|
Provider Name | Johneen Hardwick |
First Address | Los Alamitos, CA 90720-5438 |
Second Address | Los Alamitos, CA 90720-5438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2014 |
Last Update Date | 26/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30480 | MASSAGE THERAPIST LICENSE (01) | CA |