Healthcare Provider Details

I. General information

NPI: 1881968022
Provider Name (Legal Business Name): FIRST DIABETES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20535 E WALNUT DR N
WALNUT CA
91789-2945
US

IV. Provider business mailing address

20535 E WALNUT DR N
WALNUT CA
91789-2945
US

V. Phone/Fax

Practice location:
  • Phone: 909-598-5700
  • Fax: 909-598-5709
Mailing address:
  • Phone: 909-598-5700
  • Fax: 909-598-5709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. TA SIU
Title or Position: PRESIDENT
Credential:
Phone: 909-598-5700