Healthcare Provider Details

I. General information

NPI: 1770637217
Provider Name (Legal Business Name): BELEN BUNDA LONTOC CERTIFIED MASSAGE TH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11306 VENTURA BLVD
STUDIO CITY CA
91604-3137
US

IV. Provider business mailing address

16324 PARTHENIA ST
NORTH HILLS CA
91343-4705
US

V. Phone/Fax

Practice location:
  • Phone: 818-763-7628
  • Fax:
Mailing address:
  • Phone: 818-416-9965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberP85070955
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: