Organization
MYODETOX CALIFORNIA PC INC.
Active
Other names
Myodetox
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT MARCACCIO (ASSISTANT SECRETARY)
(917) 327-0019
Entity
Organization
Contact information
Practice address
8354 SANTA MONICA BLVD, WEST HOLLYWOOD, CA 90069-4313
(323) 831-2455
Mailing address
8354 SANTA MONICA BLVD, WEST HOLLYWOOD, CA 90069-4313
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
04/21/2023
Last updated
04/21/2023
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