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General NPI Number Information
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NPI Number | 1750019865
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Entity Type | Organization
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Legal Business Name | ADVANCED BODYWORKS OF CALIFORNIA, INC.
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Dates
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Enumeration Date | 08/09/2022
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 222 N MOUNTAIN AVE STE 210A
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City | UPLAND
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State | CA
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Zip | 91786-5714
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Country | US
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Telephone | 833-473-2233
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Fax |
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Provider Business Mailing Address
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Address Line | 222 N MOUNTAIN AVE STE 210A
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City | UPLAND
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State | CA
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Zip | 91786-5714
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Country | US
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Telephone | 833-473-2233
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ROSSANA DIAZ
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Credential | CMT, MMP
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Telephone | 626-905-6330
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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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