Healthcare Provider Details

I. General information

NPI: 1457985533
Provider Name (Legal Business Name): QUALITY OF LIFE HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1442 IRVINE BLVD
TUSTIN CA
92780-3801
US

IV. Provider business mailing address

1442 IRVINE BLVD
TUSTIN CA
92780-3801
US

V. Phone/Fax

Practice location:
  • Phone: 714-544-3900
  • Fax:
Mailing address:
  • Phone: 714-544-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANA BALLERINI
Title or Position: OWNER, AUTHORIZED OFFICIAL
Credential:
Phone: 714-544-3900