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General NPI Number Information
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NPI Number | 1356869895
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Entity Type | Organization
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Legal Business Name | TETRA PHARMACEUTICAL INC
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 09/05/2017
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Provider Practice Location Address
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Address Line | 1611 POMONA RD STE 211
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City | CORONA
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State | CA
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Zip | 92880-6924
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Country | US
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Telephone | 866-398-5883
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Fax | 866-937-4944
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Provider Business Mailing Address
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Address Line | 32295 MISSION TRL # 8-312
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-2305
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Country | US
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Telephone | 866-398-5883
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Fax | 866-936-4943
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Authorized Official
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Title or Position | MANAGER
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Name | MS. RENEE JONES
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Credential |
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Telephone | 866-398-5883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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