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General NPI Number Information
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NPI Number | 1851508287
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Entity Type | Organization
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Legal Business Name | MEDPRO, LLC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 157 AVENIDA SERRA
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4760
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Country | US
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Telephone | 949-492-3514
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Fax | 949-366-2390
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Provider Business Mailing Address
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Address Line | PO BOX 1359
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City | SAN CLEMENTE
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State | CA
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Zip | 92674-1359
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Country | US
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Telephone | 949-492-3514
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Fax | 949-366-2390
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Authorized Official
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Title or Position | PRESIDENT
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Name | KARA LYNN NORDBERG
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Credential |
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Telephone | 949-492-3514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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