Healthcare Provider Details

I. General information

NPI: 1669920658
Provider Name (Legal Business Name): NEW AGE INFUSIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 TWIN CREEKS DR
SAN RAMON CA
94583-1860
US

IV. Provider business mailing address

2545 TWIN CREEKS DR
SAN RAMON CA
94583-1860
US

V. Phone/Fax

Practice location:
  • Phone: 510-415-5921
  • Fax:
Mailing address:
  • Phone: 510-415-5921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: LORNISE DENEE LOGAN-BERRY
Title or Position: OWNER
Credential:
Phone: 510-415-5921