Healthcare Provider Details

I. General information

NPI: 1952866220
Provider Name (Legal Business Name): CONNIE BATTLE LICENSE MASSAGE THER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21880 HAWTHORNE BLVD # 30533939
TORRANCE CA
90503-7031
US

IV. Provider business mailing address

21880 HAWTHORNE BLVD # 30533939
TORRANCE CA
90503-7031
US

V. Phone/Fax

Practice location:
  • Phone: 424-477-2168
  • Fax:
Mailing address:
  • Phone: 424-477-2168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: