Provider Demographics
NPI:1073261806
Name:HOGUE, MACHARA LYNETTE (CMT)
Entity Type:Individual
Prefix:
First Name:MACHARA
Middle Name:LYNETTE
Last Name:HOGUE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24414 MARIGOLD AVE
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-1827
Mailing Address - Country:US
Mailing Address - Phone:310-872-7216
Mailing Address - Fax:855-978-1718
Practice Address - Street 1:3756 SANTA ROSALIA DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3606
Practice Address - Country:US
Practice Address - Phone:562-774-3373
Practice Address - Fax:855-978-1718
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80028225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist