Individual
MR. JUSTIN FORMANEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CMT
Contact information
Practice address
28720 ROADSIDE DR STE 177, AGOURA HILLS, CA 91301-4570
(805) 586-5934
Mailing address
805 CALLE CANON, CAMARILLO, CA 93012-7165
(805) 586-5934
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
89452
CA
Other
Enumeration date
05/01/2024
Last updated
05/01/2024
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