Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 3090 | CA |
NPI | 1013273762 |
---|---|
Provider Name | Joy Laraine Athans |
First Address | San Diego, CA 92103-4884 |
Second Address | San Diego, CA 92103-6529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2012 |
Last Update Date | 06/04/2012 |