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General NPI Number Information
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NPI Number | 1386451383
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Entity Type | Organization
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Legal Business Name | HOLISTIC LIFE CARE
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 415 S PROSPECT AVE APT 220
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City | REDONDO BEACH
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State | CA
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Zip | 90277-3946
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Country | US
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Telephone | 424-360-5998
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Fax |
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Provider Business Mailing Address
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Address Line | 415 S PROSPECT AVE APT 220
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City | REDONDO BEACH
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State | CA
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Zip | 90277-3946
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Country | US
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Telephone | 424-360-5998
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | JACOB RAFAEL DELGADO
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Credential |
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Telephone | 424-360-5998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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