=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184792202
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WORLEYS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2006
-----------------------------------------------------
Last Update Date | 06/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 828 B ST
-----------------------------------------------------
City | HAYWARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94541-5108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-782-8500
-----------------------------------------------------
Fax | 510-300-1899
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 828 B ST
-----------------------------------------------------
City | HAYWARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94541-5108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-782-8500
-----------------------------------------------------
Fax | 510-300-1899
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. STEVEN WORLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-782-8500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 17192
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------