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NPI Code Detail

MEDICARE: DIANA BOHAN CMT

MEDICARE: DIANA BOHAN 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
1225700000XMassage Therapist92972CA

General Provider Information

NPI Number : 1972282127
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA BOHAN CMT
Provider Business Mailing Address
First Line : 3460 OCEAN VIEW BLVD STE B
Second Line :
City : GLENDALE
State : CA
Zip : 91208-3306
Country : US
Telephone Number : 626-515-4401
Fax Number :
Provider Business Practice Location Address
First Line : 3460 OCEAN VIEW BLVD STE B
Second Line :
City : GLENDALE
State : CA
Zip : 91208-3306
Country : US
Telephone Number : 626-515-4401
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2023
Last Update Date : 07/14/2023

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Directions to “ DIANA BOHAN CMT” Practice Location

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