# SOLANDSOUL MEDICAL GROUP, A PROFESSIONAL MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Luzwave Integrative Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659913291
- **Authorized official:** LINDA MACK (ADMINISTRATOR)
- **Authorized official phone:** (949) 527-6400

## Contact information

- **Practice address:** 14642 NEWPORT AVE STE 105, TUSTIN, CA 92780-6058
- **Practice address phone:** (949) 527-6410
- **Practice address fax:** (714) 486-2309
- **Mailing address:** 14642 NEWPORT AVE STE 105, TUSTIN, CA 92780-6058
- **Mailing address phone:** (949) 527-6400
- **Mailing address fax:** (714) 486-2309

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 10/15/2019
- **Last updated:** 03/17/2020