MEDICARE: MS. BELEN BUNDA LONTOC CERTIFIED MASSAGE TH

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	P85070955	CA

General Provider Information

NPI Number	:	1770637217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BELEN BUNDA LONTOC CERTIFIED MASSAGE TH

Provider Business Mailing Address
First Line	:	16324 PARTHENIA ST
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-4705
Country	:	US
Telephone Number	:	818-416-9965
Fax Number	:

Provider Business Practice Location Address
First Line	:	11306 VENTURA BLVD
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3137
Country	:	US
Telephone Number	:	818-763-7628
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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