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General NPI Number Information
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NPI Number | 1821665811
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Entity Type | Individual
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Provider Name | FUAD PHILLIP ALAN OSCEOLA
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Gender | Male
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 19730 VENTURA BLVD STE 104
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-2600
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Country | US
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Telephone | 646-825-0969
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Fax |
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Provider Business Mailing Address
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Address Line | 860 OLD TOPANGA CANYON RD
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City | TOPANGA
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State | CA
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Zip | 90290-3818
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Country | US
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Telephone | 646-825-0969
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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 | 26930
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License Number State | CA
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