Provider Demographics
NPI:1033637194
Name:SMITH, NAKIA DANIELLE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:NAKIA
Middle Name:DANIELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4927 MINTURN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-3113
Mailing Address - Country:US
Mailing Address - Phone:310-621-1951
Mailing Address - Fax:
Practice Address - Street 1:4318 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1152
Practice Address - Country:US
Practice Address - Phone:562-788-3104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19750225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist