Provider Demographics
NPI:1447848650
Name:NASH, LATONYA (CERTIFIED MASSAGE TX)
Entity type:Individual
Prefix:
First Name:LATONYA
Middle Name:
Last Name:NASH
Suffix:
Gender:F
Credentials:CERTIFIED MASSAGE TX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7381 LA TIJERA BLVD UNIT 452411
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-7134
Mailing Address - Country:US
Mailing Address - Phone:310-896-5673
Mailing Address - Fax:
Practice Address - Street 1:10969 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3341
Practice Address - Country:US
Practice Address - Phone:310-896-5673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
76211225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician