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General NPI Number Information
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NPI Number | 1790914679
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Entity Type | Organization
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Legal Business Name | SANTA ANITA MEDICAL EQUIPMENT INC
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Dates
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Enumeration Date | 07/13/2009
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Last Update Date | 09/16/2009
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Provider Practice Location Address
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Address Line | 9245 RESEDA BLVD SUITE 743
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City | NORTHRIDGE
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State | CA
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Zip | 91324-3137
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Country | US
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Telephone | 818-304-1936
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Fax |
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Provider Business Mailing Address
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Address Line | 9245 RESEDA BLVD SUITE 743
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City | NORTHRIDGE
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State | CA
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Zip | 91324-3137
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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 | CEO
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Name | ALISA GHEREGA
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Credential |
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Telephone | 818-304-1936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 05D1101030
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License Number State | CA
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