Healthcare Provider Details

I. General information

NPI: 1164282190
Provider Name (Legal Business Name): OC LIFESTYLE AND OBESITY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S ANAHEIM HILLS RD STE 246
ANAHEIM CA
92807-4760
US

IV. Provider business mailing address

1290 N FAIRBURY LN
ANAHEIM CA
92807-2531
US

V. Phone/Fax

Practice location:
  • Phone: 951-258-4596
  • Fax:
Mailing address:
  • Phone: 951-258-4596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SADIA F MOINUDDIN
Title or Position: CEO
Credential: MD
Phone: 951-258-4596