Healthcare Provider Details

I. General information

NPI: 1144535063
Provider Name (Legal Business Name): LOTUS WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E LINCOLN AVE
ORANGE CA
92865-1905
US

IV. Provider business mailing address

900 E LINCOLN AVE
ORANGE CA
92865-1905
US

V. Phone/Fax

Practice location:
  • Phone: 714-637-6370
  • Fax:
Mailing address:
  • Phone: 714-637-6370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC31690
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11790
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6915
License Number StateCA

VIII. Authorized Official

Name: DR. DEEPAK MOOSAD
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 714-315-3033