Healthcare Provider Details

I. General information

NPI: 1801094842
Provider Name (Legal Business Name): IOL MEDICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 RUSSET CT
WALNUT CREEK CA
94598-4652
US

IV. Provider business mailing address

7373 UNIVERSITY AVE STE 110
LA MESA CA
91941-6023
US

V. Phone/Fax

Practice location:
  • Phone: 925-457-8828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: LEONID GRINSHPAN
Title or Position: CFO
Credential:
Phone: 925-457-8828