Healthcare Provider Details

I. General information

NPI: 1134068612
Provider Name (Legal Business Name): YONATAN PATINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7403 RESEDA BLVD
RESEDA CA
91335-2819
US

IV. Provider business mailing address

2649 LEDSON WAY
PALMDALE CA
93550-6555
US

V. Phone/Fax

Practice location:
  • Phone: 323-616-4505
  • Fax:
Mailing address:
  • Phone: 323-616-4505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number40065941Z
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: