Provider Demographics
NPI:1821829748
Name:NANTATONG, ARNONT
Entity type:Individual
Prefix:
First Name:ARNONT
Middle Name:
Last Name:NANTATONG
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 1:9707 CANTERBURY AVE
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-5211
Mailing Address - Country:US
Mailing Address - Phone:818-404-3554
Mailing Address - Fax:
Practice Address - Street 1:9707 CANTERBURY AVE
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-5211
Practice Address - Country:US
Practice Address - Phone:818-404-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22971225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist