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General NPI Number Information
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NPI Number | 1508158486
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Entity Type | Organization
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Legal Business Name | LIGHTEN UP HEALTH CENTER
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 4020 BIRCH ST SUITE 201
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2213
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Country | US
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Telephone | 949-252-8111
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Fax |
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Provider Business Mailing Address
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Address Line | 4020 BIRCH ST SUITE 201
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2213
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Country | US
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Telephone | 949-252-8111
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | RON LEON
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Credential |
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Telephone | 949-252-8111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | N/A
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License Number State | CA
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