Oc Light House

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Legal business name

OC LIGHT HOUSE

Practice address

150 S Prospect Ave
Tustin, CA 92780-3617

Phone

(310) 505-7717

NPI assigned

Aug 26, 2019

Last updated

Aug 26, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Maria Christina Eyssallenne

Title

Managing Member

Phone

(310) 505-7717

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1566777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566777600000",
    "number": "1376191148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 S PROSPECT AVE",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803617",
            "telephone_number": "310-505-7717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 S PROSPECT AVE",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803617",
            "telephone_number": "310-505-7717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OC LIGHT HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-26",
        "last_updated": "2019-08-26",
        "status": "A",
        "authorized_official_last_name": "EYSSALLENNE",
        "authorized_official_first_name": "MARIA CHRISTINA",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "310-505-7717"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mainoffice@oclighthouse.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "150 S Prospect Ave",
            "city": "Tustin",
            "state": "CA",
            "country_code": "US",
            "postal_code": "927803617",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Student in an Organized Health Care Education/Training Program in Tustin, CA
• Providers in Tustin, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; 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.