Healthcare Provider Details

I. General information

NPI: 1811658164
Provider Name (Legal Business Name): CIPHEROME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 01/07/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 ZANKER RD STE 105
SAN JOSE CA
95134-2119
US

IV. Provider business mailing address

2860 ZANKER RD STE 105
SAN JOSE CA
95134-2119
US

V. Phone/Fax

Practice location:
  • Phone: 650-714-6290
  • Fax:
Mailing address:
  • Phone: 650-714-6290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. KIRK JOHNSON
Title or Position: CFO
Credential:
Phone: 650-714-6290