MEDICARE: CRYSTAL JOY HONECK HHP, CMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	NVMT.5944	NV
2	225700000X	Massage Therapist	60248	CA

General Provider Information

NPI Number	:	1790379717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL JOY HONECK HHP, CMT

Provider Business Mailing Address
First Line	:	39442 LONG RIDGE DR
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92591-4533
Country	:	US
Telephone Number	:	619-500-6236
Fax Number	:

Provider Business Practice Location Address
First Line	:	4002 PARK BLVD STE A1
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2689
Country	:	US
Telephone Number	:	619-500-6236
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	02/22/2021

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