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General NPI Number Information
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NPI Number | 1700674769
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Entity Type | Organization
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Legal Business Name | REFLECTIVE WELLNESS LLC
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Dates
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Enumeration Date | 04/29/2025
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 22471 ASPAN ST STE 290
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City | LAKE FOREST
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State | CA
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Zip | 92630-1655
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Country | US
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Telephone | 714-813-6317
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Fax |
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Provider Business Mailing Address
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Address Line | 22471 ASPAN ST STE 290
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City | LAKE FOREST
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State | CA
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Zip | 92630-1655
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | DEREK WALSH
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Credential |
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Telephone | 949-735-1576
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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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