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General NPI Number Information
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NPI Number | 1538508668
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Entity Type | Organization
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Legal Business Name | THE ISGROUP
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 1247 LINCOLN BLVD # 221
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City | SANTA MONICA
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State | CA
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Zip | 90401-1700
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Country | US
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Telephone | 310-319-0097
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Fax |
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Provider Business Mailing Address
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Address Line | 1247 LINCOLN BLVD # 221
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City | SANTA MONICA
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State | CA
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Zip | 90401-1700
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Country | US
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Telephone | 310-319-0097
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. JOHN SIMMONS
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Credential |
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Telephone | 310-319-0097
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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 | 199913110063
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License Number State | CA
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