Healthcare Provider Details

I. General information

NPI: 1487746327
Provider Name (Legal Business Name): PEARL VENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 E COOLEY DR STE N
COLTON CA
92324-3949
US

IV. Provider business mailing address

1012 E COOLEY DR STE N
COLTON CA
92324-3949
US

V. Phone/Fax

Practice location:
  • Phone: 909-422-8005
  • Fax: 909-824-1080
Mailing address:
  • Phone: 909-422-8005
  • Fax: 909-824-1080

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: MR. OFONIME UKPONG
Title or Position: MANAGER
Credential:
Phone: 909-422-8005