Provider Demographics
NPI:1417719477
Name:JONES, SANDRENE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:SANDRENE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 257TH ST APT 10
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-5304
Mailing Address - Country:US
Mailing Address - Phone:323-788-4098
Mailing Address - Fax:
Practice Address - Street 1:1532 257TH ST APT 10
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-5304
Practice Address - Country:US
Practice Address - Phone:323-788-4098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58192225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist