Healthcare Provider Details

I. General information

NPI: 1750834719
Provider Name (Legal Business Name): IAATK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E WALNUT AVE
LOMPOC CA
93436-6835
US

IV. Provider business mailing address

PO BOX 1
LOMPOC CA
93438-0001
US

V. Phone/Fax

Practice location:
  • Phone: 805-737-4357
  • Fax:
Mailing address:
  • Phone: 805-737-4357
  • Fax: 805-735-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number424700001
License Number StateCA

VIII. Authorized Official

Name: MR. PABLO SANDOVAL MARTINEZ
Title or Position: PRESIDENT
Credential:
Phone: 805-737-4357