Provider Demographics
NPI:1861969008
Name:HEALTHY ME OC
Entity type:Organization
Organization Name:HEALTHY ME OC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TALLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HACATORYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:949-632-3118
Mailing Address - Street 1:4569 MACARTHUR COURT
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4569 MACARTHUR COURT
Practice Address - Street 2:SUITE 1100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-632-3118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902313752OtherTYPE 1 NPI