Healthcare Provider Details

I. General information

NPI: 1366005597
Provider Name (Legal Business Name): TATYANA STEELE-HALL LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2019
Last Update Date: 04/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 WILSHIRE BLVD STE 214
BEVERLY HILLS CA
90212-2004
US

IV. Provider business mailing address

155 S ST ANDREWS PL APT 3
LOS ANGELES CA
90004-5081
US

V. Phone/Fax

Practice location:
  • Phone: 661-703-5995
  • Fax:
Mailing address:
  • Phone: 661-703-5995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18488
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number60221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: