Healthcare Provider Details

I. General information

NPI: 1104150358
Provider Name (Legal Business Name): 2GORJIS INTEGRATED HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 GREGORY LN STE 210
PLEASANT HILL CA
94523-4922
US

IV. Provider business mailing address

PO BOX 4403
WALNUT CREEK CA
94596-0403
US

V. Phone/Fax

Practice location:
  • Phone: 925-932-8602
  • Fax:
Mailing address:
  • Phone: 925-689-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberZ21679
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number43135
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberMASSAGE THERAPIST
License Number StateCA

VIII. Authorized Official

Name: KIM M EVANS
Title or Position: OWNER
Credential: MESSAGE THERAPIST
Phone: 925-689-8602