Active NPI
Ellicia Novella Moore, CMT
- Massage Therapist
- Los Angeles, CA
National Provider Identifier
1700758141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 99760
- Practice address
- 912 S Dacotah St
Los Angeles, CA 90023-1623 - Phone
- (310) 591-0326
- NPI assigned
- Sep 23, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 99760 | CA | Primary |
Addresses
Primary practice location
912 S Dacotah St
Los Angeles, CA 90023-1623
Mailing address
912 S Dacotah St
Los Angeles, CA 90023-1623
Phone (310) 591-0326
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 99760 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1758585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758585600000",
"number": "1700758141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "912 S DACOTAH ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900231623",
"telephone_number": "310-591-0326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "912 S DACOTAH ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900231623",
"telephone_number": "310-591-0326"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "ELLICIA",
"middle_name": "NOVELLA",
"credential": "CMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-09-23",
"last_updated": "2025-09-23",
"certification_date": "2025-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "CA",
"license": "99760",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.