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General NPI Number Information
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NPI Number | 1134263130
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Entity Type | Organization
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Legal Business Name | DOC'S MEDICAL MART
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1004 E BIDWELL ST
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City | FOLSOM
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State | CA
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Zip | 95630-5564
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Country | US
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Telephone | 916-984-4460
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Fax | 916-984-4541
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Provider Business Mailing Address
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Address Line | 19100 BIG BASIN WAY
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City | BOULDER CREEK
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State | CA
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Zip | 95006-8570
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Country | US
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Telephone | 831-338-6552
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Fax | 831-338-7777
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Authorized Official
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Title or Position | OWNER
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Name | JOCELYN BISCHOFF
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Credential |
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Telephone | 831-338-6522
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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 | CA
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