Healthcare Provider Details

I. General information

NPI: 1346394145
Provider Name (Legal Business Name): SYSTIK MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 CYPRESS DR
PETALUMA CA
94954-5694
US

IV. Provider business mailing address

3920 CYPRESS DR
PETALUMA CA
94954-5694
US

V. Phone/Fax

Practice location:
  • Phone: 707-765-3141
  • Fax: 707-776-2682
Mailing address:
  • Phone: 707-765-3141
  • Fax: 707-776-2682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberSRJH99159048
License Number StateCA

VIII. Authorized Official

Name: MR. EDWARD J BORACCHIA
Title or Position: CEO
Credential:
Phone: 707-765-3100