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General NPI Number Information
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NPI Number | 1104148501
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Entity Type | Organization
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Legal Business Name | MIND-BODY MEDICAL UNIVERSITY
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Dates
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Enumeration Date | 02/26/2010
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Last Update Date | 02/26/2010
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Provider Practice Location Address
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Address Line | 790 E COLORADO BLVD STE. 907A
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City | PASADENA
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State | CA
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Zip | 91101-2113
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Country | US
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Telephone | 888-488-6268
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Fax | 888-630-5992
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Provider Business Mailing Address
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Address Line | 790 E COLORADO BLVD STE. 907A
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City | PASADENA
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State | CA
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Zip | 91101-2113
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Country | US
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Telephone | 888-488-6268
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Fax | 888-630-5992
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Authorized Official
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Title or Position | DIRECTOR
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Name | PROF. JASON LIU
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Credential | PH.D.
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Telephone | 626-588-7815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | AC11816
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License Number State | CA
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