Provider Demographics
NPI:1265153571
Name:THANAPHINYOKUL-RIPPLE, WACHIRA
Entity type:Individual
Prefix:
First Name:WACHIRA
Middle Name:
Last Name:THANAPHINYOKUL-RIPPLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2268 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-2517
Mailing Address - Country:US
Mailing Address - Phone:323-369-4243
Mailing Address - Fax:
Practice Address - Street 1:2268 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-2517
Practice Address - Country:US
Practice Address - Phone:323-369-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49736225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist