Provider Demographics
NPI:1770359945
Name:DE BILLIE, DAVID
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:DE BILLIE
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 1:6621 E PACIFIC COAST HWY STE 120
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4244
Mailing Address - Country:US
Mailing Address - Phone:562-414-5001
Mailing Address - Fax:562-414-5002
Practice Address - Street 1:6621 E PACIFIC COAST HWY STE 120
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4244
Practice Address - Country:US
Practice Address - Phone:562-414-5001
Practice Address - Fax:562-414-5002
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1032225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist