Healthcare Provider Details

I. General information

NPI: 1467559146
Provider Name (Legal Business Name): SOUTHLAND RESPIRATORY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11711 STERLING AVE STE D
RIVERSIDE CA
92503-4973
US

IV. Provider business mailing address

11711 STERLING AVE STE D
RIVERSIDE CA
92503-4973
US

V. Phone/Fax

Practice location:
  • Phone: 951-785-4232
  • Fax: 951-785-4242
Mailing address:
  • Phone: 951-785-4232
  • Fax: 951-785-4242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateCA

VIII. Authorized Official

Name: ALLAN MANIO
Title or Position: PRESIDENT
Credential:
Phone: 951-588-3946