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General NPI Number Information
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NPI Number | 1578707014
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Entity Type | Organization
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Legal Business Name | LVN MEDICAL
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Dates
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Enumeration Date | 04/28/2009
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Last Update Date | 04/28/2009
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Provider Practice Location Address
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Address Line | 1127 MANZANA WAY
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City | SAN DIEGO
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State | CA
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Zip | 92139-1438
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Country | US
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Telephone | 619-253-6514
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Fax | 619-568-3585
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Provider Business Mailing Address
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Address Line | 1127 MANZANA WAY
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City | SAN DIEGO
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State | CA
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Zip | 92139-1438
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Country | US
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Telephone | 619-253-6514
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Fax | 619-568-3585
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARTIN R DURAN
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Credential | LVN
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Telephone | 619-253-6514
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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 | B2009003649
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License Number State | CA
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