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General NPI Number Information
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NPI Number | 1578843397
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Entity Type | Organization
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Legal Business Name | PREVENTATIVERX
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 24882 SEA AIRE
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City | DANA POINT
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State | CA
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Zip | 92629-1848
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Country | US
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Telephone | 949-322-1509
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Fax | 949-661-1901
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Provider Business Mailing Address
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Address Line | 24882 SEA AIRE
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City | DANA POINT
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State | CA
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Zip | 92629-1848
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | STEVE SCHROEDER
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Credential |
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Telephone | 310-722-9733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State | CA
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