Provider Demographics
NPI:1376289710
Name:ADVANCE WELLNESS PEARL L.L.C
Entity Type:Organization
Organization Name:ADVANCE WELLNESS PEARL L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:707-710-0072
Mailing Address - Street 1:625 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4141
Mailing Address - Country:US
Mailing Address - Phone:707-710-0072
Mailing Address - Fax:
Practice Address - Street 1:740 S DORA ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5336
Practice Address - Country:US
Practice Address - Phone:707-710-0072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty