Provider Demographics
NPI:1225481112
Name:CONARKOV, JOSEPH (CMT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:CONARKOV
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19425 SOLEDAD CANYON RD # 457
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-2632
Mailing Address - Country:US
Mailing Address - Phone:818-679-6346
Mailing Address - Fax:
Practice Address - Street 1:19425 SOLEDAD CANYON RD # 457
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-2632
Practice Address - Country:US
Practice Address - Phone:818-679-6346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70975225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist