Healthcare Provider Details

I. General information

NPI: 1487575700
Provider Name (Legal Business Name): PANADDA TUGGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2796 CRESTON DR
LOS ANGELES CA
90068-2260
US

IV. Provider business mailing address

2796 CRESTON DR
LOS ANGELES CA
90068-2260
US

V. Phone/Fax

Practice location:
  • Phone: 213-756-3968
  • Fax:
Mailing address:
  • Phone: 213-756-3968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number93821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: