Healthcare Provider Details

I. General information

NPI: 1396149902
Provider Name (Legal Business Name): 911 BIOCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 BROOKSIDE AVE
REDLANDS CA
92373-4608
US

IV. Provider business mailing address

316 BROOKSIDE AVE
REDLANDS CA
92373-4608
US

V. Phone/Fax

Practice location:
  • Phone: 855-901-0911
  • Fax:
Mailing address:
  • Phone: 855-901-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberG37096
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License NumberG37096
License Number StateCA

VIII. Authorized Official

Name: BARBARA BARTEL
Title or Position: MANAGER
Credential:
Phone: 909-816-3800