Provider Demographics
NPI:1598154817
Name:CLAGON, PAULA MICHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MICHELLE
Last Name:CLAGON
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:PO BOX 3991
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-3991
Mailing Address - Country:US
Mailing Address - Phone:310-801-5865
Mailing Address - Fax:
Practice Address - Street 1:2510 MONTEREY ST
Practice Address - Street 2:3991
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90510-0400
Practice Address - Country:US
Practice Address - Phone:310-801-5865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48710225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist