Oc Breast Wellness LLC

Primary specialty

Exercise & Sports PsychologistTaxonomy code 103TE1100X

Legal business name

OC BREAST WELLNESS LLC

Practice address

11770 Warner Ave Ste 112
Fountain Valley, CA 92708-2659

Phone

(714) 363-5595

NPI assigned

Aug 1, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Janice Salmon

Title

Director

Phone

(714) 717-5334

Specialties & licenses 1

Addresses

Other names 1

• OC Breast Wellness LLC Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659312000000",
    "number": "1326774340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11770 WARNER AVE STE 112",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927082659",
            "telephone_number": "714-363-5595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11770 WARNER AVE STE 112",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927082659",
            "telephone_number": "714-363-5595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OC BREAST WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-01",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A",
        "authorized_official_last_name": "SALMON",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "714-717-5334"
    },
    "taxonomies": [
        {
            "code": "103TE1100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Exercise & Sports",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OC Breast Wellness LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Psychologist in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.