Provider Demographics
NPI:1679445217
Name:MAROLO, ANDREA ELIZABETH (LMT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ELIZABETH
Last Name:MAROLO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4006 EAST BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-4644
Mailing Address - Country:US
Mailing Address - Phone:424-230-2159
Mailing Address - Fax:
Practice Address - Street 1:11282 WASHINGTON BLVD # 106
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4641
Practice Address - Country:US
Practice Address - Phone:424-230-2159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93423225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist