Healthcare Provider Details

I. General information

NPI: 1275479651
Provider Name (Legal Business Name): EMBODIED HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BARRANCA ST STE 715
WEST COVINA CA
91791-1647
US

IV. Provider business mailing address

100 N BARRANCA ST STE 715
WEST COVINA CA
91791-1647
US

V. Phone/Fax

Practice location:
  • Phone: 626-761-5922
  • Fax:
Mailing address:
  • Phone: 626-761-5922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: VERONICA CASTANEDA-JIMENEZ
Title or Position: ADMINISTRATOR
Credential: LMFT
Phone: 626-761-5922