Individual
JOHNNY DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
222 N ACACIA AVE, SOLANA BEACH, CA 92075-1106
(760) 529-7679
Mailing address
222 N ACACIA AVE, SOLANA BEACH, CA 92075-1106
(760) 529-7679
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
19564
CA
Other
Enumeration date
02/27/2017
Last updated
02/27/2017
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