Provider Demographics
NPI:1396979795
Name:HEALING ARTS MEDICAL CLINIC
Entity type:Organization
Organization Name:HEALING ARTS MEDICAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OMD LAC
Authorized Official - Phone:310-547-3332
Mailing Address - Street 1:1366 W 7TH ST
Mailing Address - Street 2:SUITE 4 B
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3500
Mailing Address - Country:US
Mailing Address - Phone:310-547-3332
Mailing Address - Fax:310-547-9532
Practice Address - Street 1:1366 W 7TH ST
Practice Address - Street 2:SUITE 4 B
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3500
Practice Address - Country:US
Practice Address - Phone:310-547-3332
Practice Address - Fax:310-547-9532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 21667111N00000X
CAAC 10137171100000X
CADC 27614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 27614OtherCHIROPRACTIC
CADC 21667OtherCHIROPRACTIC