Provider Demographics
NPI:1912032665
Name:ANNETTE CHAMPO, CLMT
Entity Type:Organization
Organization Name:ANNETTE CHAMPO, CLMT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPO
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:626-744-1501
Mailing Address - Street 1:936 E GREEN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2900
Mailing Address - Country:US
Mailing Address - Phone:626-744-1501
Mailing Address - Fax:
Practice Address - Street 1:936 E GREEN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2900
Practice Address - Country:US
Practice Address - Phone:626-744-1501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty