Provider Demographics
NPI:1063840361
Name:BODY BOXING BOOTCAMP
Entity type:Organization
Organization Name:BODY BOXING BOOTCAMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-435-3820
Mailing Address - Street 1:142 S WETHERLY DR APT 302
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-2928
Mailing Address - Country:US
Mailing Address - Phone:310-435-3820
Mailing Address - Fax:
Practice Address - Street 1:142 S WETHERLY DR APT 302
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-2928
Practice Address - Country:US
Practice Address - Phone:310-435-3820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0002708997-0001-2174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty