Healthcare Provider Details

I. General information

NPI: 1306001151
Provider Name (Legal Business Name): MNANNA WORLD,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11619 DUENDA RD
SAN DIEGO CA
92127
US

IV. Provider business mailing address

11619 DUENDA RD
SAN DIEGO CA
92127-1110
US

V. Phone/Fax

Practice location:
  • Phone: 858-487-7800
  • Fax:
Mailing address:
  • Phone: 858-487-7800
  • Fax: 858-487-0092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. SUN J LEE
Title or Position: PRESIDENT
Credential: C.PED
Phone: 858-487-7800