MEDICARE: SVETLANA POMA

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
1	225700000X	Massage Therapist	85467	CA

General Provider Information

NPI Number	:	1962181271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SVETLANA POMA

Provider Business Mailing Address
First Line	:	7521 HAMPTON AVE APT 204
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5541
Country	:	US
Telephone Number	:	805-280-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	7521 HAMPTON AVE APT 204
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5541
Country	:	US
Telephone Number	:	805-280-1200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2023
Last Update Date	:	07/13/2023

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Directions to “ SVETLANA POMA ” Practice Location

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