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General NPI Number Information
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NPI Number | 1154616233
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Entity Type | Organization
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Legal Business Name | OBJECT RADIANCE, INC.
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 38207 CALLE CIPRES
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City | MURRIETA
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State | CA
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Zip | 92562-9348
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Country | US
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Telephone | 951-698-9422
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Fax | 951-240-3405
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Provider Business Mailing Address
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Address Line | 38207 CALLE CIPRES
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City | MURRIETA
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State | CA
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Zip | 92562-9348
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Country | US
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Telephone | 951-698-9422
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Fax | 951-240-3405
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | ATMA K KHALSA
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Credential | LVN
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Telephone | 951-698-9422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number |
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License Number State |
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