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General NPI Number Information
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NPI Number | 1447691019
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Entity Type | Organization
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Legal Business Name | SOJOURN
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Dates
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Enumeration Date | 07/11/2013
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Last Update Date | 07/11/2013
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Provider Practice Location Address
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Address Line | 310 N IRWIN ST STE 29
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City | HANFORD
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State | CA
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Zip | 93230-4479
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Country | US
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Telephone | 559-707-1841
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Fax |
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Provider Business Mailing Address
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Address Line | 310 NORTH IRWIN STREET #29
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City | HANFORD
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State | CA
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Zip | 93230
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Country | US
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Telephone | 559-707-1841
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Fax |
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Authorized Official
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Title or Position | OWNER/CERTIFIED MASSAGE THERAPIST
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Name | LUCIANNA BORBA JOHNSTON
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Credential | CMT
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Telephone | 559-707-1841
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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 | 2193
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License Number State | CA
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