Healthcare Provider Details

I. General information

NPI: 1659409233
Provider Name (Legal Business Name): EQUINE ASSISTED THERAPY AT MOUNTAIN VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 LOMA ALTA RD
CARMEL CA
93923-9432
US

IV. Provider business mailing address

524 LOMA ALTA RD
CARMEL CA
93923-9432
US

V. Phone/Fax

Practice location:
  • Phone: 831-656-9447
  • Fax: 831-373-1944
Mailing address:
  • Phone: 831-656-9447
  • Fax: 831-373-1944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID BATES
Title or Position: SECRETARY AND TREASURER
Credential:
Phone: 831-656-9447