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General NPI Number Information
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NPI Number | 1659097210
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Entity Type | Individual
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Provider Name | NATTHANAN THIRARUTNALINTHANA
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Gender | Female
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 18910 VENTURA BLVD
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City | TARZANA
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State | CA
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Zip | 91356-2024
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Country | US
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Telephone | 619-964-5169
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Fax |
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Provider Business Mailing Address
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Address Line | 4750 KESTER AVE APT 24
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-2024
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Country | US
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Telephone | 619-964-5169
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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 | 71717
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License Number State | CA
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