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General NPI Number Information
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NPI Number | 1467873646
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Entity Type | Organization
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Legal Business Name | WATERGREEN MEDICAL SUPPLY INC
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Dates
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Enumeration Date | 12/14/2013
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Last Update Date | 12/14/2013
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Provider Practice Location Address
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Address Line | 2875 DOUGLAS WAY
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City | CORONA
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State | CA
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Zip | 92882-6066
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Country | US
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Telephone | 714-651-8059
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Fax |
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Provider Business Mailing Address
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Address Line | 2875 DOUGLAS WAY
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City | CORONA
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State | CA
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Zip | 92882-6066
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Country | US
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Telephone | 714-651-8059
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RON TREJO
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Credential |
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Telephone | 714-651-8059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number |
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License Number State |
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