Provider Demographics
NPI:1881432185
Name:EPHRAIM, FREDDIE MITCHELL (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:FREDDIE
Middle Name:MITCHELL
Last Name:EPHRAIM
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9663 SANTA MONICA BLVD # 417
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:310-628-6288
Mailing Address - Fax:310-276-1277
Practice Address - Street 1:415 N OAKHURST DR APT 308
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4051
Practice Address - Country:US
Practice Address - Phone:310-628-6288
Practice Address - Fax:310-276-1277
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44939225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist