Provider Demographics
NPI:1609159193
Name:IMPACT HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:IMPACT HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAGON
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:949-954-6225
Mailing Address - Street 1:2025 NEWPORT BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2162
Mailing Address - Country:US
Mailing Address - Phone:949-954-6225
Mailing Address - Fax:
Practice Address - Street 1:2025 NEWPORT BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2162
Practice Address - Country:US
Practice Address - Phone:949-954-6225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAMTC 20733172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty