Healthcare Provider Details

I. General information

NPI: 1023991262
Provider Name (Legal Business Name): ME MEDSPA & WELLNESS CLINIC PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24134 SUNNYMEAD BLVD
MORENO VALLEY CA
92553-3096
US

IV. Provider business mailing address

24134 SUNNYMEAD BLVD STE A
MORENO VALLEY CA
92553-3096
US

V. Phone/Fax

Practice location:
  • Phone: 818-459-2646
  • Fax:
Mailing address:
  • Phone: 818-459-2646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MARILYN OYAN LAPAIX
Title or Position: ADMINISTRATOR-VICE PRESIDENT
Credential: NP
Phone: 818-459-2646