Healthcare Provider Details

I. General information

NPI: 1396668216
Provider Name (Legal Business Name): SHARE OUR SELVES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S POPLAR ST
SANTA ANA CA
92704-4321
US

IV. Provider business mailing address

20151 SW BIRCH ST STE 100
NEWPORT BEACH CA
92660-1794
US

V. Phone/Fax

Practice location:
  • Phone: 949-270-2100
  • Fax: 949-650-4458
Mailing address:
  • Phone: 949-270-2100
  • Fax: 949-650-4458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: NICOLE MACHADO
Title or Position: CHIEF COMPLIANCE & ADMIN OFFICER
Credential:
Phone: 949-270-2135