Provider Demographics
NPI:1770637217
Name:LONTOC, BELEN BUNDA (CERTIFIED MASSAGE TH)
Entity Type:Individual
Prefix:MS
First Name:BELEN
Middle Name:BUNDA
Last Name:LONTOC
Suffix:
Gender:F
Credentials:CERTIFIED MASSAGE TH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16324 PARTHENIA ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-4705
Mailing Address - Country:US
Mailing Address - Phone:818-416-9965
Mailing Address - Fax:
Practice Address - Street 1:11306 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3137
Practice Address - Country:US
Practice Address - Phone:818-763-7628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP85070955225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist