Provider Demographics
NPI:1104150358
Name:2GORJIS INTEGRATED HEALTH & WELLNESS
Entity type:Organization
Organization Name:2GORJIS INTEGRATED HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MESSAGE THERAPIST
Authorized Official - Phone:925-689-8602
Mailing Address - Street 1:PO BOX 4403
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-0403
Mailing Address - Country:US
Mailing Address - Phone:925-689-8602
Mailing Address - Fax:
Practice Address - Street 1:81 GREGORY LN STE 210
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4922
Practice Address - Country:US
Practice Address - Phone:925-932-8602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43135225700000X
133NN1002X
CAZ21679207N00000X
CAMASSAGE THERAPIST305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305S00000XManaged Care OrganizationsPoint of Service
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty