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General NPI Number Information
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NPI Number | 1003607896
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Entity Type | Individual
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Provider Name | ELEARY NIXON MASSAGE THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 13357 BURBANK BLVD APT 1
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City | SHERMAN OAKS
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State | CA
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Zip | 91401-5360
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Country | US
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Telephone | 818-621-5629
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Fax |
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Provider Business Mailing Address
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Address Line | 3015 S B ST
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City | OXNARD
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State | CA
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Zip | 93033-5249
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 84866
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License Number State | CA
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