Healthcare Provider Details

I. General information

NPI: 1457502817
Provider Name (Legal Business Name): FLH PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 NEWPORT CENTER DR SUITE 1100
NEWPORT BEACH CA
92660-6420
US

IV. Provider business mailing address

620 NEWPORT CENTER DR SUITE 1100
NEWPORT BEACH CA
92660-6420
US

V. Phone/Fax

Practice location:
  • Phone: 949-200-4629
  • Fax: 816-719-4255
Mailing address:
  • Phone: 949-200-4629
  • Fax: 816-719-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberA97068
License Number StateCA

VIII. Authorized Official

Name: DR. SHARI S. MUIR
Title or Position: PRESIDENT
Credential: MD
Phone: 949-200-4629