Healthcare Provider Details

I. General information

NPI: 1134060569
Provider Name (Legal Business Name): DIVINE WELLNESS SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28901 S WESTERN AVE STE 225
RANCHO PALOS VERDES CA
90275-0824
US

IV. Provider business mailing address

28901 S WESTERN AVE STE 225
RANCHO PALOS VERDES CA
90275-0824
US

V. Phone/Fax

Practice location:
  • Phone: 424-267-6251
  • Fax:
Mailing address:
  • Phone: 424-267-6251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NANCY SKOBLAR
Title or Position: OWNER
Credential: MBR,RN
Phone: 424-267-6251