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General NPI Number Information
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NPI Number | 1588915532
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Entity Type | Organization
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Legal Business Name | PHYSICIAN SUPPORT SERVICE
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Dates
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Enumeration Date | 09/30/2012
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Last Update Date | 09/30/2012
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Provider Practice Location Address
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Address Line | 8780 19TH ST # 201
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City | ALTA LOMA
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State | CA
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Zip | 91701-4608
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Country | US
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Telephone | 619-995-0252
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Fax |
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Provider Business Mailing Address
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Address Line | 8780 19TH ST # 201
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City | ALTA LOMA
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State | CA
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Zip | 91701-4608
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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 | BILLING DEP
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Name | RAFA CASTRO
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Credential |
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Telephone | 619-995-0252
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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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