Healthcare Provider Details

I. General information

NPI: 1811813439
Provider Name (Legal Business Name): IVORY ELOISE MCCOWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 S CATALINA AVE
REDONDO BEACH CA
90277-5255
US

IV. Provider business mailing address

2240 OLIVE AVE
LONG BEACH CA
90806-4440
US

V. Phone/Fax

Practice location:
  • Phone: 213-491-3659
  • Fax:
Mailing address:
  • Phone: 213-491-3659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number102577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: