Provider Demographics
NPI:1174164917
Name:LUZWAVE ART OF HEALING INC.
Entity type:Organization
Organization Name:LUZWAVE ART OF HEALING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-527-6400
Mailing Address - Street 1:14642 NEWPORT AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6058
Mailing Address - Country:US
Mailing Address - Phone:951-801-5566
Mailing Address - Fax:951-801-5566
Practice Address - Street 1:14642 NEWPORT AVE STE 105
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6058
Practice Address - Country:US
Practice Address - Phone:949-527-6400
Practice Address - Fax:714-486-2309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty