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General NPI Number Information
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NPI Number | 1588021810
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Entity Type | Individual
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Provider Name | JONATHAN WARE
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Gender | Male
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Dates
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Enumeration Date | 01/17/2016
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Last Update Date | 01/17/2016
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Provider Practice Location Address
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Address Line | 295 REDONDO AVE SUITE 103
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City | LONG BEACH
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State | CA
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Zip | 90803-5900
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Country | US
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Telephone | 562-704-6480
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Fax |
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Provider Business Mailing Address
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Address Line | 2925 E 7TH ST APT 310
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City | LONG BEACH
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State | CA
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Zip | 90804-4858
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Country | US
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Telephone | 310-866-0834
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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 | 62591
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License Number State | CA
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