Healthcare Provider Details

I. General information

NPI: 1396558680
Provider Name (Legal Business Name): OC HEALTH WELLNESS GROUP CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 E KATELLA AVE STE B
ORANGE CA
92867-4857
US

IV. Provider business mailing address

438 E KATELLA AVE STE B
ORANGE CA
92867-4857
US

V. Phone/Fax

Practice location:
  • Phone: 714-744-5985
  • Fax: 714-744-5000
Mailing address:
  • Phone: 714-744-5985
  • Fax: 714-744-5000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA SAMANTHA LAYSON
Title or Position: OWNER
Credential: NP
Phone: 714-744-5985