Healthcare Provider Details

I. General information

NPI: 1275447344
Provider Name (Legal Business Name): RELIANCE GREY SARAZEN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30885 E THOUSAND OAKS BLVD
WESTLAKE VILLAGE CA
91362-4039
US

IV. Provider business mailing address

1733 N CHEROKEE AVE APT 6
LOS ANGELES CA
90028-4673
US

V. Phone/Fax

Practice location:
  • Phone: 818-351-1997
  • Fax:
Mailing address:
  • Phone: 702-250-6851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12647
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number103601
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: