Healthcare Provider Details

I. General information

NPI: 1154616233
Provider Name (Legal Business Name): OBJECT RADIANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38207 CALLE CIPRES
MURRIETA CA
92562-9348
US

IV. Provider business mailing address

38207 CALLE CIPRES
MURRIETA CA
92562-9348
US

V. Phone/Fax

Practice location:
  • Phone: 951-698-9422
  • Fax: 951-240-3405
Mailing address:
  • Phone: 951-698-9422
  • Fax: 951-240-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number
License Number State

VIII. Authorized Official

Name: ATMA K KHALSA
Title or Position: VICE PRESIDENT
Credential: LVN
Phone: 951-698-9422