Individual
PORNSUDA DOKTHONGHOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13456 WASHINGTON BLVD, MARINA DEL REY, CA 90292-5626
(916) 847-9429
Mailing address
10326 ALMAYO AVE APT 304, LOS ANGELES, CA 90064-5213
(916) 847-9429
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
83900
CA
Other
Enumeration date
10/11/2021
Last updated
10/11/2021
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