Individual
MARCO ANTONIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11611 SAN VICENTE BLVD, LOS ANGELES, CA 90049-5106
(925) 476-1767
Mailing address
3020 ROWENA AVE APT 102, LOS ANGELES, CA 90039-2081
(818) 209-0336
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
91285
CA
Other
Enumeration date
03/21/2024
Last updated
03/22/2024
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