Provider Demographics
NPI:1770307464
Name:CALIFORNIA COLLEGE OF PHYSICAL ARTS, INC.
Entity type:Organization
Organization Name:CALIFORNIA COLLEGE OF PHYSICAL ARTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MANGANO
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:714-964-7744
Mailing Address - Street 1:18582 BEACH BLVD STE 11
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2071
Mailing Address - Country:US
Mailing Address - Phone:714-964-7744
Mailing Address - Fax:714-500-0949
Practice Address - Street 1:18582 BEACH BLVD STE 11
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2071
Practice Address - Country:US
Practice Address - Phone:714-964-7744
Practice Address - Fax:714-500-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty