Healthcare Provider Details

I. General information

NPI: 1811522592
Provider Name (Legal Business Name): PRECISION PATIENT OUTCOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 GILMAN ST
BERKELEY CA
94710-1422
US

IV. Provider business mailing address

808 GILMAN ST
BERKELEY CA
94710-1422
US

V. Phone/Fax

Practice location:
  • Phone: 707-266-3133
  • Fax:
Mailing address:
  • Phone: 707-266-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MARGRETT P LEWIS
Title or Position: CEO
Credential:
Phone: 707-266-3133