Healthcare Provider Details

I. General information

NPI: 1336939222
Provider Name (Legal Business Name): RELAXED AND RESTORED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 WASHINGTON PL STE 112
LOS ANGELES CA
90066-5000
US

IV. Provider business mailing address

11600 WASHINGTON PL STE 112
LOS ANGELES CA
90066-5000
US

V. Phone/Fax

Practice location:
  • Phone: 323-332-1485
  • Fax:
Mailing address:
  • Phone: 323-332-1485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIMBERLY HALEY
Title or Position: OWNER
Credential: CMT
Phone: 323-456-6770