Provider Demographics
NPI:1801092895
Name:BODYSCOPE INSTITUTE LLC
Entity type:Organization
Organization Name:BODYSCOPE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR LICENSED PRACTITIONE
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MS HHP
Authorized Official - Phone:949-515-8004
Mailing Address - Street 1:500 OLD NEWPORT BLVD
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4234
Mailing Address - Country:US
Mailing Address - Phone:949-515-8004
Mailing Address - Fax:949-515-8014
Practice Address - Street 1:500 OLD NEWPORT BLVD
Practice Address - Street 2:SUITE 200A
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4234
Practice Address - Country:US
Practice Address - Phone:949-515-8004
Practice Address - Fax:949-515-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHHP040902133N00000X
CALAC AC3606171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty