Provider Demographics
NPI:1598183873
Name:MAEYAMA, LYNN (CMT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:MAEYAMA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2390 CRENSHAW BLVD # E123
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3300
Mailing Address - Country:US
Mailing Address - Phone:310-749-9330
Mailing Address - Fax:
Practice Address - Street 1:23377 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3720
Practice Address - Country:US
Practice Address - Phone:424-241-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20090225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist