Individual
MR. MARK EDWARD VENNERHOLM II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CMT
Contact information
Practice address
2305 S MELROSE DR STE 103, VISTA, CA 92081-8789
(760) 230-3898
Mailing address
208 B AVE APT A, CORONADO, CA 92118-1998
(940) 206-1838
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
93040
CA
Other
Enumeration date
03/13/2023
Last updated
03/13/2023
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