Provider Demographics
NPI:1033454913
Name:HEALTH ATLAST COSTA MESA
Entity Type:Organization
Organization Name:HEALTH ATLAST COSTA MESA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STAMM-CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-515-4006
Mailing Address - Street 1:1835 NEWPORT BLVD
Mailing Address - Street 2:SUITE D251
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-5031
Mailing Address - Country:US
Mailing Address - Phone:949-515-4006
Mailing Address - Fax:949-515-4036
Practice Address - Street 1:1835 NEWPORT BLVD
Practice Address - Street 2:SUITE D251
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-5031
Practice Address - Country:US
Practice Address - Phone:949-515-4006
Practice Address - Fax:949-515-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29893111N00000X
CA32233111N00000X
CAA55104208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty