Provider Demographics
NPI:1952146599
Name:OC RENEWAL THERAPY CENTER LLC
Entity type:Organization
Organization Name:OC RENEWAL THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSARIO
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:BARAJAS
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:949-446-4446
Mailing Address - Street 1:23521 PASEO DE VALENCIA STE B11
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3145
Mailing Address - Country:US
Mailing Address - Phone:949-422-2093
Mailing Address - Fax:949-446-4446
Practice Address - Street 1:23521 PASEO DE VALENCIA STE B11
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3145
Practice Address - Country:US
Practice Address - Phone:949-422-2093
Practice Address - Fax:949-446-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty