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General NPI Number Information
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NPI Number | 1336655430
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Entity Type | Individual
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Provider Name | GANTUYA DAVAA
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Gender | Female
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Dates
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Enumeration Date | 12/27/2017
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Last Update Date | 12/27/2017
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Provider Practice Location Address
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Address Line | 209 TORRANCE BLVD
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City | REDONDO BEACH
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State | CA
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Zip | 90277-3303
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Country | US
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Telephone | 310-798-2707
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Fax |
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Provider Business Mailing Address
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Address Line | 20820 ANZA AVE APT 122
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City | TORRANCE
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State | CA
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Zip | 90503-4282
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Country | US
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Telephone | 213-290-8652
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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 | 74881
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License Number State | CA
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