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General NPI Number Information
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NPI Number | 1831302272
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Entity Type | Organization
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Legal Business Name | MEDICAL HEALING CENTER
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 23361 EL TORO RD STE 106
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City | LAKE FOREST
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State | CA
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Zip | 92630-4810
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Country | US
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Telephone | 949-855-8119
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Fax | 949-855-6328
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Provider Business Mailing Address
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Address Line | 23361 EL TORO RD STE 106
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City | LAKE FOREST
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State | CA
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Zip | 92630-4810
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Country | US
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Telephone | 949-855-8119
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Fax | 949-855-6328
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Authorized Official
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Title or Position | BILLER
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Name | MR. JOE MATTHEW HERCENKO
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Credential |
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Telephone | 949-855-8119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5374
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License Number State | CA
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