=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356048946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INFUSION PUMP REPAIR CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2023
-----------------------------------------------------
Last Update Date | 02/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1421 EDINGER AVE STE C
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92780-6287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-686-4379
-----------------------------------------------------
Fax | 949-385-5818
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1421 EDINGER AVE STE C
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92780-6287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-686-4379
-----------------------------------------------------
Fax | 949-385-5818
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HASSAN SERHAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-686-4379
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2472B0301X
-----------------------------------------------------
Taxonomy Name | Biomedical Engineering Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------