Provider Demographics
NPI:1174094809
Name:TOTAL HEALTH
Entity type:Organization
Organization Name:TOTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIDOMENICANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-597-7925
Mailing Address - Street 1:14650 AVIATION BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6667
Mailing Address - Country:US
Mailing Address - Phone:310-725-9016
Mailing Address - Fax:310-325-3041
Practice Address - Street 1:14650 AVIATION BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6667
Practice Address - Country:US
Practice Address - Phone:310-725-9016
Practice Address - Fax:310-325-3041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760587364OtherNON MEDICARE