Provider Demographics
NPI:1891474292
Name:GUNCIC, JANINE M (CMT)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:M
Last Name:GUNCIC
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:M
Other - Last Name:AVALOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMT
Mailing Address - Street 1:5053 WAVERLY DR
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-2650
Mailing Address - Country:US
Mailing Address - Phone:562-309-5311
Mailing Address - Fax:
Practice Address - Street 1:5053 WAVERLY DR
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-2650
Practice Address - Country:US
Practice Address - Phone:562-309-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79495225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist