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General NPI Number Information
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NPI Number | 1528810397
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Entity Type | Organization
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Legal Business Name | HOLISTIC CLINIC LLC
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Dates
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Enumeration Date | 04/03/2024
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 1048 E PENNSYLVANIA AVE
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City | ESCONDIDO
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State | CA
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Zip | 92025-4617
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Country | US
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Telephone | 407-343-4744
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Fax |
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Provider Business Mailing Address
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Address Line | 1048 E PENNSYLVANIA AVE
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City | ESCONDIDO
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State | CA
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Zip | 92025-4617
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Country | US
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Telephone | 407-343-4744
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MISS NOEMI AMADOR
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Credential | CLINICAL IRIDOLOGY
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Telephone | 407-343-4744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SH1100X
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Taxonomy Name | Holistic Clinical Nurse Specialist
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License Number |
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License Number State |
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