Healthcare Provider Details

I. General information

NPI: 1871249102
Provider Name (Legal Business Name): DRAGONFLY REMEDY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39755 MURRIETA HOT SPRINGS RD STE D160
MURRIETA CA
92563-9113
US

IV. Provider business mailing address

PO BOX 890302
TEMECULA CA
92589-0302
US

V. Phone/Fax

Practice location:
  • Phone: 951-295-7038
  • Fax: 951-602-6902
Mailing address:
  • Phone: 951-295-7038
  • Fax: 951-602-6902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLA SANTANA
Title or Position: OWNER
Credential: LMFT
Phone: 951-295-7038