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1760079347
JOHNNIE SAN NICOLAS
PORTLAND, OR
NPI
1760079347
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225700000X Massage Therapist
(Licence: OR 26117)
Enumeration Date
2020-12-29
Last Update Date
2020-12-29
Business Address
JOHNNIE SAN NICOLAS
3241 NE BROADWAY ST
PORTLAND, OR 97232-1814
Phone number: 503-282-8582
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Mailing Address
JOHNNIE SAN NICOLAS
3241 NE BROADWAY ST
PORTLAND, OR 97232-1814
Phone number: 503-282-8582
Copy
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