Healthcare Provider Details

I. General information

NPI: 1386795011
Provider Name (Legal Business Name): PENINSULA BIOMEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WHISPERING PINES DR SUITE 115
SCOTTS VALLEY CA
95066-4792
US

IV. Provider business mailing address

PO BOX 66149
SCOTTS VALLEY CA
95067-6149
US

V. Phone/Fax

Practice location:
  • Phone: 831-430-9066
  • Fax: 831-430-9068
Mailing address:
  • Phone: 831-430-9066
  • Fax: 831-430-9068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number2676
License Number StateCA

VIII. Authorized Official

Name: MRS. ANNDEE HAFNER
Title or Position: GENERAL MANAGER
Credential:
Phone: 831-430-9066