Healthcare Provider Details

I. General information

NPI: 1114766516
Provider Name (Legal Business Name): MOUNTAINTOP TECHNOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S FAIRMONT AVE
LODI CA
95240-3835
US

IV. Provider business mailing address

10050 RICHARD IBARRA WAY
ELK GROVE CA
95757-6439
US

V. Phone/Fax

Practice location:
  • Phone: 732-322-9919
  • Fax:
Mailing address:
  • Phone: 732-322-9919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. REGINALD GORING
Title or Position: CEO
Credential: MBA, NHA
Phone: 732-322-9919