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General NPI Number Information
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NPI Number | 1790960615
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Entity Type | Organization
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Legal Business Name | BLUE SPARROW CORPORATION
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 1475 S STATE COLLEGE BLVD SUITE 222
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City | ANAHEIM
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State | CA
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Zip | 92806-5701
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Country | US
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Telephone | 714-772-1203
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Fax | 714-772-1213
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Provider Business Mailing Address
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Address Line | 1475 S STATE COLLEGE BLVD SUITE 222
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City | ANAHEIM
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State | CA
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Zip | 92806-5701
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Country | US
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Telephone | 714-772-1203
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Fax | 714-772-1213
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Authorized Official
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Title or Position | CEO
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Name | MR. BAPI S MOHANTY
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Credential |
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Telephone | 714-772-1203
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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 | CA
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