Healthcare Provider Details

I. General information

NPI: 1700217346
Provider Name (Legal Business Name): NEW LIFE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13844 ALTON PKWY SUITE 134
IRVINE CA
92618-1620
US

IV. Provider business mailing address

13844 ALTON PKWY SUITE 134
IRVINE CA
92618-1620
US

V. Phone/Fax

Practice location:
  • Phone: 949-436-3376
  • Fax: 800-665-1218
Mailing address:
  • Phone: 949-436-3376
  • Fax: 800-665-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number11888
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number14346
License Number StateCA

VIII. Authorized Official

Name: MS. GUIQIN AN
Title or Position: OWNER
Credential:
Phone: 949-351-0280