Healthcare Provider Details

I. General information

NPI: 1679866784
Provider Name (Legal Business Name): BODYLOGICS HEALTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12730 FOOTHILL BLVD. UNIT 102
RANCHO CUCAMONGA CA
91739
US

IV. Provider business mailing address

12730 FOOTHILL BLVD. UNIT 102
RANCHO CUCAMONGA CA
91739
US

V. Phone/Fax

Practice location:
  • Phone: 909-438-7005
  • Fax:
Mailing address:
  • Phone: 909-438-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEVE BROWN
Title or Position: CLINICAL PSYCHOLOGIST
Credential:
Phone: 626-589-9600