Organization
111 FASHION LANE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AGNES YEN SINCLAIR (MANAGER)
(626) 429-9290
Entity
Organization
Contact information
Practice address
111 FASHION LN, TUSTIN, CA 92780-3306
(714) 619-8636
(866) 646-1488
Mailing address
111 FASHION LN, TUSTIN, CA 92780-3306
(714) 619-8636
(866) 646-1488
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Enumeration date
05/14/2021
Last updated
05/14/2021
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