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Organization
OC LIGHT HOUSE
Active
Organization
OC LIGHT HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA CHRISTINA EYSSALLENNE (MANAGING MEMBER)
(310) 505-7717
Entity
Organization
Contact information
Practice address
150 S PROSPECT AVE, TUSTIN, CA 92780-3617
(310) 505-7717
Mailing address
150 S PROSPECT AVE, TUSTIN, CA 92780-3617
(310) 505-7717
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/26/2019
Last updated
08/26/2019
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