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General NPI Number Information
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NPI Number | 1619294626
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Entity Type | Organization
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Legal Business Name | MEDISPHERE INC.
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 11/30/2010
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Provider Practice Location Address
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Address Line | 482 W ARROW HWY SUITE E
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City | SAN DIMAS
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State | CA
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Zip | 91773-2941
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Country | US
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Telephone | 909-592-4633
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Fax |
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Provider Business Mailing Address
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Address Line | 482 W ARROW HWY SUITE E
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City | SAN DIMAS
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State | CA
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Zip | 91773-2941
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Country | US
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Telephone | 909-592-4633
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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. DARIN FLASHBERG
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Credential |
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Telephone | 626-922-8202
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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 | 53388
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License Number State | CA
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