Healthcare Provider Details

I. General information

NPI: 1053077800
Provider Name (Legal Business Name): DRIP DROP HYDRATE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 11/16/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10999 RIVERSIDE DR STE 103
STUDIO CITY CA
91602-2239
US

IV. Provider business mailing address

10999 RIVERSIDE DR STE 103
STUDIO CITY CA
91602-2239
US

V. Phone/Fax

Practice location:
  • Phone: 818-643-5004
  • Fax:
Mailing address:
  • Phone: 818-643-5004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MKRTICH DANIYELYAN
Title or Position: CEO
Credential:
Phone: 818-643-5004