Individual
BRUCE KENYON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
972 TICO RD # 972, OJAI, CA 93023-3558
(805) 798-5493
Mailing address
972 TICO RD, OJAI, CA 93023-3558
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
85216
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
94480096G40269
—
CA
Enumeration date
02/16/2021
Last updated
02/16/2021
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