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General NPI Number Information
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NPI Number | 1750825857
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Entity Type | Organization
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Legal Business Name | SOUL SOURCE THERAPEUTIC DEVICES, INC.
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 5404 WHITSETT AVE #205
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91607-1615
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Country | US
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Telephone | 818-574-0078
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Fax | 503-892-5787
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Provider Business Mailing Address
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Address Line | 5404 WHITSETT AVE #205
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91607-1615
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Country | US
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Telephone | 818-574-0078
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Fax | 503-892-5787
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. LLOYD SILVERSTEIN
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Credential |
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Telephone | 818-574-0078
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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 |
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License Number State |
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