MEDICARE: NU LACE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1316142938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NU LACE INC

Provider Business Mailing Address
First Line	:	3214 ADAMS AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-1644
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3214 ADAMS AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-1644
Country	:	US
Telephone Number	:	832-489-9257
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. LACEY WILLIAMS
Credential	:
Telephone Number	:	832-489-9257

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	12/03/2008

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Directions to “NU LACE INC ” Practice Location

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