Provider Demographics
NPI:1255153987
Name:BRUER, TASHA
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:BRUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10008 NATIONAL BLVD # 254
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3809
Mailing Address - Country:US
Mailing Address - Phone:818-457-8634
Mailing Address - Fax:
Practice Address - Street 1:7918 RESEDA BLVD APT 209
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1991
Practice Address - Country:US
Practice Address - Phone:818-457-8634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96816225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist