Healthcare Provider Details

I. General information

NPI: 1518650167
Provider Name (Legal Business Name): JUNHUA GUAN MA 61275237
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 SE BRADY RD
CAMAS WA
98607-8476
US

IV. Provider business mailing address

15420 NE 70TH ST
VANCOUVER WA
98682-3882
US

V. Phone/Fax

Practice location:
  • Phone: 360-513-9208
  • Fax:
Mailing address:
  • Phone: 360-947-7586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61275237
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: