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General NPI Number Information
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NPI Number | 1134060569
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Entity Type | Organization
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Legal Business Name | DIVINE WELLNESS SPA
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Dates
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Enumeration Date | 04/01/2026
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Last Update Date | 04/01/2026
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Provider Practice Location Address
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Address Line | 28901 S WESTERN AVE STE 225
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-0824
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Country | US
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Telephone | 424-267-6251
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Fax |
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Provider Business Mailing Address
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Address Line | 28901 S WESTERN AVE STE 225
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-0824
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Country | US
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Telephone | 424-267-6251
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NANCY SKOBLAR
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Credential | MBR,RN
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Telephone | 424-267-6251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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