Individual
GAVIN MADDOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MASSAGE THERAPIST
Contact information
Practice address
17672 BEACH BLVD STE E, HUNTINGTON BEACH, CA 92647-6836
(909) 533-1614
Mailing address
2230 ROSALIA DR, FULLERTON, CA 92835-2256
(909) 533-1614
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
57336
CA
Other
Enumeration date
12/15/2023
Last updated
12/15/2023
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