Individual
MS. CHALISA THAVONRUNGKIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5440 CARLTON WAY APT 105, LOS ANGELES, CA 90027-4878
(213) 268-1246
Mailing address
5440 CARLTON WAY APT 105, LOS ANGELES, CA 90027-4878
(213) 268-1246
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
76682
CA
Other
Enumeration date
10/15/2020
Last updated
10/15/2020
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