Provider Demographics
NPI:1861777583
Name:ROSS, ALANI NAEAWILI (CMT)
Entity type:Individual
Prefix:
First Name:ALANI
Middle Name:NAEAWILI
Last Name:ROSS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 CLARK AVE.
Mailing Address - Street 2:#445
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712
Mailing Address - Country:US
Mailing Address - Phone:562-867-6183
Mailing Address - Fax:562-866-4740
Practice Address - Street 1:5220 CLARK AVE.
Practice Address - Street 2:#445
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712
Practice Address - Country:US
Practice Address - Phone:562-867-6183
Practice Address - Fax:562-866-4740
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10005225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist