Healthcare Provider Details

I. General information

NPI: 1750219606
Provider Name (Legal Business Name): MICHAIL FRAGKISKOS VAMVATIRAS CMT, CBS, KTP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 S CENTINELA AVE RM A
LOS ANGELES CA
90064-1007
US

IV. Provider business mailing address

2260 S CENTINELA AVE RM A
LOS ANGELES CA
90064-1007
US

V. Phone/Fax

Practice location:
  • Phone: 760-999-0064
  • Fax:
Mailing address:
  • Phone: 760-999-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number88526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: