Provider Demographics
NPI:1063840965
Name:RAYSIDE, JOY (LMT, CNC)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:RAYSIDE
Suffix:
Gender:F
Credentials:LMT, CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S OSAGE AVE
Mailing Address - Street 2:2
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-5009
Mailing Address - Country:US
Mailing Address - Phone:310-946-1261
Mailing Address - Fax:
Practice Address - Street 1:10801 NATIONAL BLVD
Practice Address - Street 2:340
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4139
Practice Address - Country:US
Practice Address - Phone:310-946-1261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47670173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist