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General NPI Number Information
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NPI Number | 1407183528
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Entity Type | Organization
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Legal Business Name | INGENIUS3 LLC
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Dates
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Enumeration Date | 11/10/2009
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Last Update Date | 04/16/2012
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Provider Practice Location Address
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Address Line | 18119 PRAIRIE AVE STE 104
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City | TORRANCE
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State | CA
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Zip | 90504-3740
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Country | US
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Telephone | 310-294-9017
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Fax | 310-844-7712
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Provider Business Mailing Address
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Address Line | 18119 PRAIRIE AVE STE 104
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City | TORRANCE
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State | CA
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Zip | 90504-3740
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Country | US
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Telephone | 310-294-9017
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Fax | 310-844-7712
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Authorized Official
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Title or Position | MANAGER
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Name | SAMUEL KWAW WAGYA
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Credential |
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Telephone | 310-294-9017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 52418
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License Number State | CA
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