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General NPI Number Information
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NPI Number | 1700638814
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Entity Type | Organization
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Legal Business Name | SHARE OUR SELVES CORPORATION
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Dates
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Enumeration Date | 04/02/2024
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 1650 ADAMS AVE
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City | COSTA MESA
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State | CA
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Zip | 92626-4958
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Country | US
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Telephone | 949-270-2100
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Fax | 949-650-4458
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Provider Business Mailing Address
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Address Line | 20151 SW BIRCH ST STE 100
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-1794
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Country | US
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Telephone | 949-270-2100
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Fax | 949-650-4458
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Authorized Official
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Title or Position | CEO
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Name | CHRISTY WARD
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Credential |
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Telephone | 949-536-3927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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