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General NPI Number Information
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NPI Number | 1609473677
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Entity Type | Organization
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Legal Business Name | DR. LIFESTYLE
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 1501 WESTCLIFF DR STE 201
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5518
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Country | US
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Telephone | 949-569-8877
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 WESTCLIFF DR STE 201
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5518
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Country | US
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Telephone | 949-569-8877
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MICAH YU
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Credential |
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Telephone | 909-837-0735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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