Healthcare Provider Details

I. General information

NPI: 1851707418
Provider Name (Legal Business Name): HAND OF PASSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 CENTURY PARK LN UNIT 218
CENTURY CITY CA
90067-3314
US

IV. Provider business mailing address

PO BOX 583152
ELK GROVE CA
95758-0055
US

V. Phone/Fax

Practice location:
  • Phone: 877-867-8556
  • Fax:
Mailing address:
  • Phone: 877-867-8556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS JOHN LOSITO
Title or Position: CLINICAL DIRECTOR
Credential: PH.D, CISM, CADDAC
Phone: 877-867-8556