Provider Demographics
NPI:1932700333
Name:ORANGE CLOVER HOLISTIC CENTER
Entity Type:Organization
Organization Name:ORANGE CLOVER HOLISTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEON
Authorized Official - Middle Name:
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC DAOM
Authorized Official - Phone:714-771-3127
Mailing Address - Street 1:1327 E KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5042
Mailing Address - Country:US
Mailing Address - Phone:714-771-3127
Mailing Address - Fax:714-406-2817
Practice Address - Street 1:1327 E KATELLA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5042
Practice Address - Country:US
Practice Address - Phone:714-771-3127
Practice Address - Fax:714-406-2817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty