MEDICARE: LIFTING SPIRITS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1619364171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFTING SPIRITS

Provider Business Mailing Address
First Line	:	17 ENCORE CT
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-2356
Country	:	US
Telephone Number	:	949-345-5577
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 ENCORE CT
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-2356
Country	:	US
Telephone Number	:	949-345-5577
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JASON ALAN JACOBS
Credential	:
Telephone Number	:	949-345-5577

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	04/22/2015

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Directions to “LIFTING SPIRITS ” Practice Location

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