Individual
NUNTHICHA MONGKOLLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11740 SAN VICENTE BLVD, LOS ANGELES, CA 90049-6610
(310) 442-1901
Mailing address
3200 E 3RD ST, LOS ANGELES, CA 90063-3014
(213) 559-7131
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
86844
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86844
MASSAGE THERAPIST CERTIFICATION
CA
Enumeration date
08/14/2021
Last updated
08/14/2021
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