| NPI | 1194914689 |
|---|---|
| Doing Business As | PROVICARE |
| Entity Type | Organization |
| Authorized Contact | AVESTA RASOULI President/ CEO 310-466-3738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CA 48181) |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2007-11-19 |