Provider Demographics
NPI:1871249102
Name:DRAGONFLY REMEDY, LLC
Entity Type:Organization
Organization Name:DRAGONFLY REMEDY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-295-7038
Mailing Address - Street 1:PO BOX 890302
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92589-0302
Mailing Address - Country:US
Mailing Address - Phone:951-295-7038
Mailing Address - Fax:951-602-6902
Practice Address - Street 1:39755 MURRIETA HOT SPRINGS RD STE D160
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-9113
Practice Address - Country:US
Practice Address - Phone:951-295-7038
Practice Address - Fax:951-602-6902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100221610Medicaid