Provider Demographics
NPI:1295385573
Name:ORANGE COUNTY COMMUNITY ACUPUNCTURE, INC.
Entity Type:Organization
Organization Name:ORANGE COUNTY COMMUNITY ACUPUNCTURE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:714-798-4325
Mailing Address - Street 1:202 FASHION LN STE 116
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3319
Mailing Address - Country:US
Mailing Address - Phone:714-798-4325
Mailing Address - Fax:
Practice Address - Street 1:202 FASHION LN STE 116
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3319
Practice Address - Country:US
Practice Address - Phone:714-798-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center