Individual
MR. SOURIGNA BERNA PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
800 MAGNOLIA AVE STE 105, CORONA, CA 92879-3123
(951) 905-0454
Mailing address
800 MAGNOLIA AVE STE 105, CORONA, CA 92879-3123
(951) 905-0454
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
70935
CA
Other
Enumeration date
06/30/2017
Last updated
07/21/2022
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