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General NPI Number Information
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NPI Number | 1760691364
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Entity Type | Organization
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Legal Business Name | IMPLANTIUM, LLC
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1700 CALIFORNIA ST STE 340
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City | SAN FRANCISCO
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State | CA
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Zip | 94109-4589
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Country | US
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Telephone | 415-931-8862
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Fax | 415-673-4582
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Provider Business Mailing Address
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Address Line | PO BOX 640747
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City | SAN FRANCISCO
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State | CA
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Zip | 94164-0747
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Country | US
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Telephone | 415-931-8862
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Fax | 415-673-4582
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Authorized Official
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Title or Position | CEO
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Name | MRS. TRUDY MAURER
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Credential |
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Telephone | 415-931-8862
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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 | 199916110010
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License Number State | CA
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