Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Johnnie San Nicolas

Individual provider Massage Therapist · NPI 1760079347

Johnnie San Nicolas is a Massage Therapist in Portland, Oregon. Practices as a sole proprietor. Licensed in Oregon.

Licensed in
OR
In the registry since
2020

Practice location Address checks out

3241 NE Broadway St
Portland, OR 97232-1814
Phone: (503) 282-8582
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Massage Therapist (primary) Taxonomy 225700000X · Licence 26117 (OR)

Record details

NPI number1760079347
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedDecember 29, 2020
Last updated in NPPESDecember 29, 2020
Certification dateDecember 29, 2020

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