Healthcare Provider Details

I. General information

NPI: 1033217344
Provider Name (Legal Business Name): CLEANMASTER INDUSTRIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7739 INDUSTRY AVE
PICO RIVERA CA
90660-4303
US

IV. Provider business mailing address

7739 INDUSTRY AVE
PICO RIVERA CA
90660-4303
US

V. Phone/Fax

Practice location:
  • Phone: 562-222-2286
  • Fax: 562-222-2287
Mailing address:
  • Phone: 562-222-2286
  • Fax: 562-222-2287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY43339
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPHA433390
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer

VIII. Authorized Official

Name: MR. JOSEPH KAHAN
Title or Position: PRESIDENT
Credential:
Phone: 562-222-2286