Provider Demographics
NPI:1881972024
Name:UNITY HOLISTIC HEALING CENTER, INC.
Entity type:Organization
Organization Name:UNITY HOLISTIC HEALING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOKOUFANDEH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-651-0025
Mailing Address - Street 1:4215 GLENCOE AVE
Mailing Address - Street 2:SUITE #215
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292
Mailing Address - Country:US
Mailing Address - Phone:310-651-0025
Mailing Address - Fax:310-855-0290
Practice Address - Street 1:8805 SANTA MONICA BLVD.
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069
Practice Address - Country:US
Practice Address - Phone:310-855-7546
Practice Address - Fax:310-855-0290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty