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General NPI Number Information
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NPI Number | 1831473313
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Entity Type | Organization
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Legal Business Name | FAMOUS FOAM
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Dates
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Enumeration Date | 10/03/2011
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 2397 SAN PABLO AVE
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City | BERKELEY
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State | CA
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Zip | 94702-2055
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Country | US
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Telephone | 510-841-9001
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Fax |
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Provider Business Mailing Address
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Address Line | 50 MOUNT WHITNEY DR
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City | SAN RAFAEL
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State | CA
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Zip | 94903-1037
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Country | US
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Telephone | 415-491-4799
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID BRADSHAW
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Credential |
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Telephone | 415-491-4799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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