Provider Demographics
NPI:1104148501
Name:MIND-BODY MEDICAL UNIVERSITY
Entity type:Organization
Organization Name:MIND-BODY MEDICAL UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-588-7815
Mailing Address - Street 1:790 E COLORADO BLVD
Mailing Address - Street 2:STE. 907A
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2113
Mailing Address - Country:US
Mailing Address - Phone:888-488-6268
Mailing Address - Fax:888-630-5992
Practice Address - Street 1:790 E COLORADO BLVD
Practice Address - Street 2:STE. 907A
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2113
Practice Address - Country:US
Practice Address - Phone:888-488-6268
Practice Address - Fax:888-630-5992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11816305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service