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General NPI Number Information
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NPI Number | 1831475797
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Entity Type | Organization
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Legal Business Name | REGENERATIONS CANCER WELLNESS FOUNDATION
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 1032 KEIKO ST
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City | LOS BANOS
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State | CA
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Zip | 93635-5213
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Country | US
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Telephone | 209-827-1960
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 186 1032 KEIKO STREET
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City | LOS BANOS
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State | CA
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Zip | 93635-0186
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Country | US
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Telephone | 209-827-1960
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. STARR CARSON CLEARY
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Credential | MFT, CES, MFT,
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Telephone | 209-827-1960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | CA
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