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General NPI Number Information
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NPI Number | 1306032743
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Entity Type | Organization
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Legal Business Name | HOLISTIC THERAPY CENTER, INC.
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 27281 LAS RAMBLAS SUITE 120
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6324
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Country | US
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Telephone | 949-348-2844
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Fax | 949-348-2866
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Provider Business Mailing Address
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Address Line | 27281 LAS RAMBLAS SUITE 120
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6324
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Country | US
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Telephone | 949-348-2844
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Fax | 949-348-2866
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARCELA I DOMINQUEZ
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Credential | M.D.
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Telephone | 949-348-2844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | C2796445
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License Number State | CA
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