1407871189 NPI number — MOTHER MANETEU MEDICAL SUPPLIES, INC

Table of content: MRS. HELEN JEAN GOLDEN APRN (NPI 1285874198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407871189 NPI number — MOTHER MANETEU MEDICAL SUPPLIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOTHER MANETEU MEDICAL SUPPLIES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407871189
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12601 SAN FERNANDO RD
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
SYLMAR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91342-7733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-364-5581
Provider Business Mailing Address Fax Number:
818-364-5582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12601 SAN FERNANDO RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
SYLMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91342-7733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-364-5581
Provider Business Practice Location Address Fax Number:
818-364-5582
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DONGMO
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
NOUBOUDEM
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
818-364-5581

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  103785 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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