Provider Demographics
NPI:1982298964
Name:OC OROFACIAL MYOLOGY, INC.
Entity Type:Organization
Organization Name:OC OROFACIAL MYOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:SARAH
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP, OMT
Authorized Official - Phone:949-365-5858
Mailing Address - Street 1:30131 TOWN CENTER DR STE 295
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2086
Mailing Address - Country:US
Mailing Address - Phone:949-365-5858
Mailing Address - Fax:
Practice Address - Street 1:30131 TOWN CENTER DR STE 295
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2086
Practice Address - Country:US
Practice Address - Phone:949-365-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1528264843OtherTYPE 1 NPI