Provider Demographics
NPI:1386451383
Name:HOLISTIC LIFE CARE
Entity type:Organization
Organization Name:HOLISTIC LIFE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-360-5998
Mailing Address - Street 1:415 S PROSPECT AVE APT 220
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3946
Mailing Address - Country:US
Mailing Address - Phone:424-360-5998
Mailing Address - Fax:
Practice Address - Street 1:415 S PROSPECT AVE APT 220
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3946
Practice Address - Country:US
Practice Address - Phone:424-360-5998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty