Healthcare Provider Details

I. General information

NPI: 1073453387
Provider Name (Legal Business Name): LIO HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 TROPHY CLUB DR
TROPHY CLUB TX
76262-5426
US

IV. Provider business mailing address

2200 TROPHY CLUB DR
TROPHY CLUB TX
76262-5426
US

V. Phone/Fax

Practice location:
  • Phone: 714-658-3329
  • Fax:
Mailing address:
  • Phone: 714-658-3329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN SHASHA
Title or Position: MANAGING MEMBER
Credential:
Phone: 714-658-3329