| NPI | 1952465270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY LYNN COOK Provider Enrollment Specialist 530-876-7915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies Oxygen Equipment & Supplies (Licence: CA 230000017) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2012-01-03 |