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General NPI Number Information
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NPI Number | 1104150358
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Entity Type | Organization
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Legal Business Name | 2GORJIS INTEGRATED HEALTH & WELLNESS
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Dates
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Enumeration Date | 09/21/2009
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Last Update Date | 07/10/2020
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Provider Practice Location Address
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Address Line | 81 GREGORY LN STE 210
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City | PLEASANT HILL
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State | CA
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Zip | 94523-4922
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Country | US
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Telephone | 925-932-8602
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4403
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City | WALNUT CREEK
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State | CA
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Zip | 94596-0403
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Country | US
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Telephone | 925-689-8602
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIM M EVANS
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Credential | MESSAGE THERAPIST
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Telephone | 925-689-8602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 43135
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | Z21679
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | MASSAGE THERAPIST
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License Number State | CA
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