Healthcare Provider Details

I. General information

NPI: 1578832077
Provider Name (Legal Business Name): SPECTOCOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CALIFORNIA ST STE 402
SAN FRANCISCO CA
94111-4828
US

IV. Provider business mailing address

8 CALIFORNIA ST STE 402
SAN FRANCISCO CA
94111-4828
US

V. Phone/Fax

Practice location:
  • Phone: 415-489-1993
  • Fax:
Mailing address:
  • Phone: 415-489-1993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH H BOGDAN
Title or Position: PRESIDENT
Credential:
Phone: 415-489-1993