Provider Demographics
NPI:1114415940
Name:MASHKE, ILANA (LMT)
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:
Last Name:MASHKE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9623 CEDROS AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-1005
Mailing Address - Country:US
Mailing Address - Phone:310-713-1583
Mailing Address - Fax:310-713-1583
Practice Address - Street 1:17401 VENTURA BLVD STE B6
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3860
Practice Address - Country:US
Practice Address - Phone:310-713-1583
Practice Address - Fax:310-713-1583
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37820225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist