MEDICARE: DATA SOFT LOGIC CORPORATION

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	251X00000X	Supports Brokerage Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	N/A	OTHER		SOFTWARE VENDOR

General Provider Information

NPI Number	:	1477084523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DATA SOFT LOGIC CORPORATION

Provider Business Mailing Address
First Line	:	16037 SHERMAN WAY
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-4023
Country	:	US
Telephone Number	:	866-430-0263
Fax Number	:

Provider Business Practice Location Address
First Line	:	16037 SHERMAN WAY
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-4023
Country	:	US
Telephone Number	:	866-430-0263
Fax Number	:

Authorized Official
Title or Position	:	CTO
Name	:	MR. JOSE SERRANO
Credential	:
Telephone Number	:	949-654-0101

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	03/21/2017

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