Provider Demographics
NPI:1568078905
Name:KOZHEBRODSKY, DANIEL (CMT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:KOZHEBRODSKY
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 N MARTEL AVE UNIT 205
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4846
Mailing Address - Country:US
Mailing Address - Phone:323-422-2323
Mailing Address - Fax:
Practice Address - Street 1:1344 N MARTEL AVE UNIT 205
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-4846
Practice Address - Country:US
Practice Address - Phone:323-422-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84618225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6D330552OtherHMO HEALTHNET