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General NPI Number Information
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NPI Number | 1366211955
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Entity Type | Organization
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Legal Business Name | ICOBO,INC
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Dates
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Enumeration Date | 12/25/2023
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Last Update Date | 12/25/2023
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Provider Practice Location Address
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Address Line | 11400 POPLAR ST
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City | LOMA LINDA
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State | CA
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Zip | 92354-3521
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Country | US
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Telephone | 909-754-0377
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Fax | 909-894-4294
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Provider Business Mailing Address
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Address Line | 11400 POPLAR ST
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City | LOMA LINDA
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State | CA
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Zip | 92354-3521
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Country | US
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Telephone | 909-754-0377
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Fax | 909-894-4294
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DORCAS DORRIS ANDERSON
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Credential | MD
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Telephone | 909-754-0377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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