Healthcare Provider Details

I. General information

NPI: 1447656418
Provider Name (Legal Business Name): SHANTI ORANGE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23461 S POINTE DR SUITE 100
LAGUNA HILLS CA
92653-1547
US

IV. Provider business mailing address

23461 S POINTE DR SUITE 100
LAGUNA HILLS CA
92653-1547
US

V. Phone/Fax

Practice location:
  • Phone: 949-452-0888
  • Fax:
Mailing address:
  • Phone: 949-452-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDSAY FITZPATRICK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 949-452-0888