Healthcare Provider Details

I. General information

NPI: 1992660609
Provider Name (Legal Business Name): JOSEPH GAUDIANO CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 BROADWAY ST
AMERICAN CANYON CA
94503-1229
US

IV. Provider business mailing address

18 MARCELLO CT
AMERICAN CANYON CA
94503-1435
US

V. Phone/Fax

Practice location:
  • Phone: 415-640-6235
  • Fax:
Mailing address:
  • Phone: 415-640-6235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: