Provider Demographics
NPI:1053036053
Name:AUSTEIN, LORI ELLEN
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ELLEN
Last Name:AUSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 CANYON DR APT A3
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-4833
Mailing Address - Country:US
Mailing Address - Phone:657-758-2909
Mailing Address - Fax:
Practice Address - Street 1:601 DAHLIA AVE
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2102
Practice Address - Country:US
Practice Address - Phone:949-694-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach