Individual
SHAUNA WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2156 BALBOA AVE, SAN DIEGO, CA 92109-4627
(352) 538-6750
Mailing address
2156 BALBOA AVE, SAN DIEGO, CA 92109-4627
(352) 538-6750
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
72110
CA
Other
Enumeration date
10/05/2021
Last updated
10/05/2021
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