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General NPI Number Information
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NPI Number | 1558787127
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Entity Type | Individual
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Provider Name | MS. AUDREY M PINO
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Gender | Female
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Dates
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Enumeration Date | 03/06/2014
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 11022 SANTA MONICA BLVD SUITE #440 -SEATON
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City | LOS ANGELES
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State | CA
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Zip | 90025-7513
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Country | US
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Telephone | 310-246-1904
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Fax |
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Provider Business Mailing Address
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Address Line | 2302 5TH ST UNIT E
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City | SANTA MONICA
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State | CA
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Zip | 90405-2454
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Country | US
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Telephone | 310-246-1904
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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 | 6006
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License Number State | CA
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