MEDICARE: COMFORT STYLE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	CLF 332084	CA

General Provider Information

NPI Number	:	1972681443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORT STYLE INC.

Provider Business Mailing Address
First Line	:	2500 E FOOTHILL BLVD
Second Line	:	110
City	:	PASADENA
State	:	CA
Zip	:	91107-3464
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 E FOOTHILL BLVD
Second Line	:	110
City	:	PASADENA
State	:	CA
Zip	:	91107-3464
Country	:	US
Telephone Number	:	626-584-9942
Fax Number	:	626-584-9963

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. AGVITA SELICHA
Credential	:
Telephone Number	:	626-712-8637

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/22/2020

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