=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548987167
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANESSA KEMLING MASSAGE THERAPIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2022
-----------------------------------------------------
Last Update Date | 10/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11901 SANTA MONICA BLVD # 110-762
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90025-2767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-228-7769
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11901 SANTA MONICA BLVD # 110-762
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90025-2767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-228-7769
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 91889
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------