Provider Demographics
NPI:1881293900
Name:PARKER, ANCHALEE SORAYUTH
Entity type:Individual
Prefix:
First Name:ANCHALEE
Middle Name:SORAYUTH
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANCHALEE
Other - Middle Name:
Other - Last Name:WONGMUKDAPITAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2039 ARTESIA BLVD APT 99
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-3050
Mailing Address - Country:US
Mailing Address - Phone:310-951-1133
Mailing Address - Fax:
Practice Address - Street 1:8929 S.SEPULVEDA BLVD, # 403
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:CA
Practice Address - Zip Code:90045-9004
Practice Address - Country:US
Practice Address - Phone:310-951-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8487225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist