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General NPI Number Information
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NPI Number | 1376306738
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Entity Type | Organization
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Legal Business Name | SOCAL RITUAL BODYWORK
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Dates
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Enumeration Date | 01/30/2024
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 31569 CANYON ESTATES DR STE 109
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City | LAKE ELSINORE
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State | CA
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Zip | 92532-0470
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Country | US
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Telephone | 702-334-7631
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Fax | 951-399-0021
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Provider Business Mailing Address
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Address Line | 35858 OCTOPUS LN
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City | WILDOMAR
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State | CA
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Zip | 92595-8095
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Country | US
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Telephone | 702-334-7631
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LAUREN AMY TUCKER
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Credential | LMT, MLD-C, CLT
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Telephone | 951-399-0019
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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 |
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License Number State |
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