Provider Demographics
NPI:1346474673
Name:BODYENTRE REDONDO BCH
Entity Type:Organization
Organization Name:BODYENTRE REDONDO BCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MAGSAYO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:310-371-5003
Mailing Address - Street 1:2925 182ND ST
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3922
Mailing Address - Country:US
Mailing Address - Phone:310-371-5003
Mailing Address - Fax:310-542-1954
Practice Address - Street 1:2925 182ND ST
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3922
Practice Address - Country:US
Practice Address - Phone:310-371-5003
Practice Address - Fax:310-542-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33356500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty