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General NPI Number Information
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NPI Number | 1770637217
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Entity Type | Individual
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Provider Name | BELEN BUNDA LONTOC CERTIFIED MASSAGE TH
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11306 VENTURA BLVD
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City | STUDIO CITY
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State | CA
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Zip | 91604-3137
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Country | US
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Telephone | 818-763-7628
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Fax |
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Provider Business Mailing Address
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Address Line | 16324 PARTHENIA ST
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City | NORTH HILLS
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State | CA
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Zip | 91343-4705
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Country | US
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Telephone | 818-416-9965
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | P85070955
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License Number State | CA
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