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General NPI Number Information
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NPI Number | 1366135246
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Entity Type | Individual
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Provider Name | AJALONI KENJANAE IRVIN
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Gender | Female
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Dates
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Enumeration Date | 05/29/2023
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Last Update Date | 05/29/2023
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Provider Practice Location Address
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Address Line | 13847 E 14TH ST STE 216
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City | SAN LEANDRO
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State | CA
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Zip | 94578-2626
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Country | US
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Telephone | 510-473-7263
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Fax |
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Provider Business Mailing Address
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Address Line | 5130 CONGRESS AVE
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City | OAKLAND
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State | CA
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Zip | 94601-5404
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Country | US
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Telephone | 510-927-0194
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 93228
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License Number State | CA
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