Provider Demographics
NPI:1508158486
Name:LIGHTEN UP HEALTH CENTER
Entity Type:Organization
Organization Name:LIGHTEN UP HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-252-8111
Mailing Address - Street 1:4020 BIRCH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2213
Mailing Address - Country:US
Mailing Address - Phone:949-252-8111
Mailing Address - Fax:
Practice Address - Street 1:4020 BIRCH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2213
Practice Address - Country:US
Practice Address - Phone:949-252-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN/A261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service