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General NPI Number Information
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NPI Number | 1063840361
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Entity Type | Organization
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Legal Business Name | BODY BOXING BOOTCAMP
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Dates
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Enumeration Date | 10/23/2013
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 142 S WETHERLY DR APT 302
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City | LOS ANGELES
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State | CA
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Zip | 90048-2928
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Country | US
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Telephone | 310-435-3820
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Fax |
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Provider Business Mailing Address
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Address Line | 142 S WETHERLY DR APT 302
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City | LOS ANGELES
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State | CA
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Zip | 90048-2928
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Country | US
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Telephone | 310-435-3820
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | KEVIN L BARRINGER
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Credential |
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Telephone | 310-435-3820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 0002708997-0001-2
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License Number State | CA
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