Healthcare Provider Details

I. General information

NPI: 1336986124
Provider Name (Legal Business Name): CAN YOU DIG IT RANCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10040 HIGHLAND AVE
LUCERNE VALLEY CA
92356-8717
US

IV. Provider business mailing address

10040 HIGHLAND AVE
LUCERNE VALLEY CA
92356-8717
US

V. Phone/Fax

Practice location:
  • Phone: 805-338-0134
  • Fax:
Mailing address:
  • Phone: 805-338-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SANDRA LYNN MAHONEY
Title or Position: FOUNDER
Credential:
Phone: 805-338-0134