| NPI | 1972307940 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | KATE GONZALEZ Provider Enrollment Analyst 469-800-8742 | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies | 
| Enumeration Date | 2025-04-01 | 
| Last Update Date | 2025-04-01 |