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General NPI Number Information
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NPI Number | 1093529463
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Entity Type | Organization
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Legal Business Name | IMPAKT MEDICAL, LLC
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Dates
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Enumeration Date | 02/05/2025
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 1700 S EL CAMINO REAL STE 204
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City | SAN MATEO
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State | CA
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Zip | 94402-3048
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Country | US
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Telephone | 650-844-8801
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Fax | 916-436-9054
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Provider Business Mailing Address
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Address Line | 9722 FAIR OAKS BLVD STE B
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City | FAIR OAKS
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State | CA
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Zip | 95628-7039
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Country | US
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Telephone | 408-480-5811
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Fax | 916-436-9054
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JASON BATEH
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Credential |
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Telephone | 916-844-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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