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General NPI Number Information
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NPI Number | 1538466024
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Entity Type | Organization
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Legal Business Name | AEROMEDIC HEALTHCARE INC.
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 10/26/2012
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Provider Practice Location Address
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Address Line | 425 W ALLEN AVE STE 110
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City | SAN DIMAS
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State | CA
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Zip | 91773-1485
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Country | US
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Telephone | 909-592-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 425 W ALLEN AVE STE 110
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City | SAN DIMAS
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State | CA
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Zip | 91773-1485
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Country | US
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Telephone | 909-592-6400
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHRISTOPHER REVILLA PASCUA
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Credential |
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Telephone | 909-592-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 54904
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License Number State | CA
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