Organization
BIOSPHERE COMPREHENSIVE LONGEVITY CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DINA A MALO RPT (DIRECTOR)
(310) 378-3456
Entity
Organization
Contact information
Practice address
23133 HAWTHORNE BLVD, #103, TORRANCE, CA 90505-3729
(310) 378-3456
Mailing address
1009 MONTEREY BLVD, HERMOSA BEACH, CA 90254-3783
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT19593
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT19593
PHYSICAL THERAPY LICENSE
CA
Enumeration date
09/20/2006
Last updated
05/23/2008
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