Healthcare Provider Details

I. General information

NPI: 1104185313
Provider Name (Legal Business Name): HARMONY WELLNESS CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30270 RANCHO VIEJO RD G
SAN JUAN CAPISTRANO CA
92675-1556
US

IV. Provider business mailing address

30270 RANCHO VIEJO RD G
SAN JUAN CAPISTRANO CA
92675-1556
US

V. Phone/Fax

Practice location:
  • Phone: 949-545-6116
  • Fax: 949-545-6117
Mailing address:
  • Phone: 949-545-6116
  • Fax: 949-545-6117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. KAISA MCDONNALL COPPOLA
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 949-545-6116