Healthcare Provider Details

I. General information

NPI: 1871107938
Provider Name (Legal Business Name): ERIKO OKUBO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 TRUDIE DR
RANCHO PALOS VERDES CA
90275-2038
US

IV. Provider business mailing address

1952 TRUDIE DR
RANCHO PALOS VERDES CA
90275-2038
US

V. Phone/Fax

Practice location:
  • Phone: 310-402-9863
  • Fax:
Mailing address:
  • Phone: 310-402-9863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number82031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: