| NPI | 1508210899 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUPRIYA DHANANJAYA MHASKAR President 909-973-3492 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: CA 40278) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 40278) |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2016-04-22 |