Healthcare Provider Details

I. General information

NPI: 1326476847
Provider Name (Legal Business Name): COMPLETE LYMPHEDEMA CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2013
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 DUBLIN BLVD SUITE 104
DUBLIN CA
94568-2821
US

IV. Provider business mailing address

11750 DUBLIN BLVD SUITE 104
DUBLIN CA
94568-2821
US

V. Phone/Fax

Practice location:
  • Phone: 925-550-3532
  • Fax: 925-831-0315
Mailing address:
  • Phone: 925-550-3532
  • Fax: 925-831-0315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT 6553
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberOT 6553
License Number StateCA

VIII. Authorized Official

Name: ALLYN ELIZABETH RANKIN-MARTINEZ
Title or Position: OWNER/CEO
Credential: OT
Phone: 925-550-3532