Healthcare Provider Details

I. General information

NPI: 1730091745
Provider Name (Legal Business Name): CHANEL LEWIS MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6218B W MANCHESTER AVE # 173
LOS ANGELES CA
90045-3801
US

IV. Provider business mailing address

1190 NEWPORT AVE UNIT 209
LONG BEACH CA
90804-6405
US

V. Phone/Fax

Practice location:
  • Phone: 310-663-2983
  • Fax:
Mailing address:
  • Phone: 310-663-2983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number101055
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: