MEDICARE: HOLISTIC THERAPY CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	C2796445	CA

General Provider Information

NPI Number	:	1306032743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC THERAPY CENTER, INC.

Provider Business Mailing Address
First Line	:	27281 LAS RAMBLAS
Second Line	:	SUITE 120
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6324
Country	:	US
Telephone Number	:	949-348-2844
Fax Number	:	949-348-2866

Provider Business Practice Location Address
First Line	:	27281 LAS RAMBLAS
Second Line	:	SUITE 120
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6324
Country	:	US
Telephone Number	:	949-348-2844
Fax Number	:	949-348-2866

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARCELA I DOMINQUEZ
Credential	:	M.D.
Telephone Number	:	949-348-2844

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	09/19/2007

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