| |
1420 S Mills Ave Ste G Lodi CA 95242-4291 | |
(209) 365-1110 | |
(209) 772-8666 |
Full Name | |
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Speciality | Durable Medical Equipment & Medical Supplies - Customized Equipment |
Location | 1420 S Mills Ave Ste G, Lodi, California |
Authorized Official Name and Position | James Brian Duhamel (OWNER) |
Authorized Official Contact | 2097729600 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 607 Valley Springs CA 95252-0607 Ph: (209) 772-9600 | 1420 S Mills Ave Ste G Lodi CA 95242-4291 Ph: (209) 365-1110 |
NPI Number | 1316158140 |
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Provider Enumeration Date | 05/24/2007 |
Last Update Date | 04/29/2019 |
Identifier | Type | State | Issuer |
---|---|---|---|
1316158140 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | 23820 (California) | Secondary |
332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | 23820 (California) | Primary |
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