=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942480751
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEALTH MEDICAL SOULTIONS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2007
-----------------------------------------------------
Last Update Date | 11/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1908 W REDONDO BEACH BLVD
-----------------------------------------------------
City | GARDENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90247-3624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-965-0467
-----------------------------------------------------
Fax | 310-965-0338
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1908 W REDONDO BEACH BLVD
-----------------------------------------------------
City | GARDENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90247-3624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-965-0467
-----------------------------------------------------
Fax | 310-965-0338
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTVE OFFICER
-----------------------------------------------------
Name | MS. DANIELA INIGUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-580-1700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 48149
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------