Provider Demographics
NPI:1669054136
Name:ZAYAS, ANDALA (CMT)
Entity type:Individual
Prefix:
First Name:ANDALA
Middle Name:
Last Name:ZAYAS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:ANDI
Other - Middle Name:
Other - Last Name:ZAYAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6735 WESTMINSTER BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3772
Mailing Address - Country:US
Mailing Address - Phone:310-415-6487
Mailing Address - Fax:
Practice Address - Street 1:6735 WESTMINSTER BLVD STE 107
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3772
Practice Address - Country:US
Practice Address - Phone:310-415-6487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-24
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73714225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA73714OtherCALIFORNIA MASSAGE THERAPY COUNCIL CERTIFICATION