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General NPI Number Information
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NPI Number | 1649284589
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Entity Type | Organization
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Legal Business Name | NTIEDO JOHNSON INYANG
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 3139 SAN PABLO AVE
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City | OAKLAND
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State | CA
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Zip | 94608-4533
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Country | US
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Telephone | 510-595-8474
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Fax | 510-595-8410
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Provider Business Mailing Address
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Address Line | 3139 SAN PABLO AVE
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City | OAKLAND
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State | CA
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Zip | 94608-4533
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Country | US
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Telephone | 510-595-8474
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Fax | 510-595-8410
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Authorized Official
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Title or Position | OWNER / CEO
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Name | MR. NTIEDO JOHNSON INYANG
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Credential |
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Telephone | 510-595-8474
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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 | 103425
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License Number State | CA
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