Provider Demographics
NPI:1639768039
Name:WILLIAMS, JOANNE PAULA
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:PAULA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOJO
Other - Middle Name:PAULA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT, CD, CPD
Mailing Address - Street 1:6140 LAUREL CANYON BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3311
Mailing Address - Country:US
Mailing Address - Phone:747-207-7560
Mailing Address - Fax:
Practice Address - Street 1:13223 VENTURA BLVD STE D
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-1801
Practice Address - Country:US
Practice Address - Phone:818-395-6192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45897225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist