Provider Demographics
NPI:1376306738
Name:SOCAL RITUAL BODYWORK
Entity Type:Organization
Organization Name:SOCAL RITUAL BODYWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:AMY
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, MLD-C
Authorized Official - Phone:702-334-7631
Mailing Address - Street 1:35858 OCTOPUS LN
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-8095
Mailing Address - Country:US
Mailing Address - Phone:702-334-7631
Mailing Address - Fax:
Practice Address - Street 1:40555 CALIFORNIA OAKS RD STE 118
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5723
Practice Address - Country:US
Practice Address - Phone:702-334-7631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty