Healthcare Provider Details

I. General information

NPI: 1619895679
Provider Name (Legal Business Name): MR. JUSTIN WAYNE YEARS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N EUCLID ST
LA HABRA CA
90631-2933
US

IV. Provider business mailing address

1001 N EUCLID ST
LA HABRA CA
90631-2933
US

V. Phone/Fax

Practice location:
  • Phone: 714-989-0039
  • Fax:
Mailing address:
  • Phone: 714-989-0039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number102863
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: