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General NPI Number Information
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NPI Number | 1356031660
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Entity Type | Organization
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Legal Business Name | SOUTH COAST TRUE HEALTH INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 05/10/2023
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 4121 WESTERLY PL STE 113
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2331
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Country | US
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Telephone | 949-287-3408
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Fax |
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Provider Business Mailing Address
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Address Line | 2271 W MALVERN AVE # 52
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City | FULLERTON
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State | CA
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Zip | 92833-2106
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Country | US
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Telephone | 714-396-7100
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JENNIFER WETZEL
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Credential | LAC
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Telephone | 714-396-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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