Provider Demographics
NPI:1437649522
Name:OGIWARA, OXANA (LMT)
Entity Type:Individual
Prefix:
First Name:OXANA
Middle Name:
Last Name:OGIWARA
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 1:1774 PRAIRIE GLEN PL
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582-2222
Mailing Address - Country:US
Mailing Address - Phone:818-877-0812
Mailing Address - Fax:
Practice Address - Street 1:1695 S SAN JACINTO AVE STE J
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5103
Practice Address - Country:US
Practice Address - Phone:760-825-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA75673OtherLICENSED MASSAGE THERAPIST