Healthcare Provider Details

I. General information

NPI: 1649404773
Provider Name (Legal Business Name): HEALTHY START CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S D ST
SAN BERNARDINO CA
92408-3217
US

IV. Provider business mailing address

1465 S D ST
SAN BERNARDINO CA
92408-3217
US

V. Phone/Fax

Practice location:
  • Phone: 909-658-5861
  • Fax: 866-243-0017
Mailing address:
  • Phone: 909-658-5861
  • Fax: 866-243-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberC32859
License Number StateCA

VIII. Authorized Official

Name: PAUL W HERMANN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-658-5861