| NPI | 1598398513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACLYN COLETTE MARTINEZ Owner 408-307-0053 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2020-09-09 |