Provider Demographics
NPI:1366781643
Name:FERJANI, PATRICIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:FERJANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MASSAGE
Other - Middle Name:BY
Other - Last Name:TRICIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HHP
Mailing Address - Street 1:4395 MENTONE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-1119
Mailing Address - Country:US
Mailing Address - Phone:619-592-3049
Mailing Address - Fax:
Practice Address - Street 1:2180 GARNET AVE
Practice Address - Street 2:SUITE 1I
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3610
Practice Address - Country:US
Practice Address - Phone:619-592-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21791174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21791Other225700000X