Individual
GREGORY MACTAVISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
PO BOX 462125, LOS ANGELES, CA 90046-8125
(310) 801-5150
Mailing address
PO BOX 462125, LOS ANGELES, CA 90046-8125
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
185
CA
Other
Enumeration date
12/11/2024
Last updated
12/27/2024
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