Provider Demographics
NPI:1659097210
Name:THIRARUTNALINTHANA, NATTHANAN
Entity Type:Individual
Prefix:
First Name:NATTHANAN
Middle Name:
Last Name:THIRARUTNALINTHANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 KESTER AVE APT 24
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2024
Mailing Address - Country:US
Mailing Address - Phone:619-964-5169
Mailing Address - Fax:
Practice Address - Street 1:18910 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2024
Practice Address - Country:US
Practice Address - Phone:619-964-5169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71717225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist