1720807258 NPI number — INSTITUTE OF ACUPUNCTURE AND LIFESTYLE MEDICINE, INC

Table of content: MR. LOUIS DIAMOND LCSW CADC (NPI 1144596370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720807258 NPI number — INSTITUTE OF ACUPUNCTURE AND LIFESTYLE MEDICINE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTE OF ACUPUNCTURE AND LIFESTYLE MEDICINE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720807258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31961 VIA GALLO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRABUCO CANYON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92679-3935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-863-5484
Provider Business Mailing Address Fax Number:
714-362-2337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30131 TOWN CENTER DR STE 270
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGUNA NIGUEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92677-2082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-229-5055
Provider Business Practice Location Address Fax Number:
714-362-2337
Provider Enumeration Date:
10/10/2024

Additional Information

Authorized Official

Authorized Official Last Name:
NIKPOUR
Authorized Official First Name:
NILOOFAR
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
949-229-5055

Provider Taxonomy Codes

  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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