Provider Demographics
NPI:1265811293
Name:TOTAL BODY ALLIANCE INC
Entity type:Organization
Organization Name:TOTAL BODY ALLIANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHARACHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-216-8152
Mailing Address - Street 1:10351 WILSHIRE BLVD # 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4736
Mailing Address - Country:US
Mailing Address - Phone:818-216-8152
Mailing Address - Fax:
Practice Address - Street 1:10351 WILSHIRE BLVD # 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4736
Practice Address - Country:US
Practice Address - Phone:818-216-8152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1841445020111N00000X
CAG50570207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty