Healthcare Provider Details

I. General information

NPI: 1972681443
Provider Name (Legal Business Name): COMFORT STYLE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E FOOTHILL BLVD 110
PASADENA CA
91107-3464
US

IV. Provider business mailing address

2500 E FOOTHILL BLVD 110
PASADENA CA
91107-3464
US

V. Phone/Fax

Practice location:
  • Phone: 626-584-9942
  • Fax: 626-584-9963
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLF 332084
License Number StateCA

VIII. Authorized Official

Name: MRS. AGVITA SELICHA
Title or Position: VICE PRESIDENT
Credential:
Phone: 626-712-8637