Provider Demographics
NPI:1457724023
Name:LESTONNAC FREE CLINIC
Entity Type:Organization
Organization Name:LESTONNAC FREE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:949-413-1619
Mailing Address - Street 1:1215 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2237
Mailing Address - Country:US
Mailing Address - Phone:714-633-4600
Mailing Address - Fax:
Practice Address - Street 1:1215 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2237
Practice Address - Country:US
Practice Address - Phone:714-644-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST JEANNE DE LESTONNAC FREE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center