Healthcare Provider Details

I. General information

NPI: 1568078905
Provider Name (Legal Business Name): DANIEL KOZHEBRODSKY CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 N MARTEL AVE UNIT 205
LOS ANGELES CA
90046-4846
US

IV. Provider business mailing address

1344 N MARTEL AVE UNIT 205
LOS ANGELES CA
90046-4846
US

V. Phone/Fax

Practice location:
  • Phone: 323-422-2323
  • Fax:
Mailing address:
  • Phone: 323-422-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number84618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: