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NPI Code Detail

MEDICARE: TRISHA LEILANI ICHIYAMA LMT

MEDICARE:   TRISHA LEILANI ICHIYAMA  LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist26559CA

General Provider Information

NPI Number : 1801601083
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRISHA LEILANI ICHIYAMA LMT
Provider Business Mailing Address
First Line : 5757 W CENTURY BLVD STE 719
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-6431
Country : US
Telephone Number : 714-392-4524
Fax Number :
Provider Business Practice Location Address
First Line : 5757 W CENTURY BLVD STE 719
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-6431
Country : US
Telephone Number : 714-392-4524
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2025
Last Update Date : 02/12/2025

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Directions to “ TRISHA LEILANI ICHIYAMA LMT” Practice Location

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