1750825857 NPI number — SOUL SOURCE THERAPEUTIC DEVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750825857 NPI number — SOUL SOURCE THERAPEUTIC DEVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUL SOURCE THERAPEUTIC DEVICES, 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:
1750825857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5404 WHITSETT AVE
Provider Second Line Business Mailing Address:
#205
Provider Business Mailing Address City Name:
NORTH HOLLYWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91607-1615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-574-0078
Provider Business Mailing Address Fax Number:
503-892-5787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5404 WHITSETT AVE
Provider Second Line Business Practice Location Address:
#205
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91607-1615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-574-0078
Provider Business Practice Location Address Fax Number:
503-892-5787
Provider Enumeration Date:
12/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SILVERSTEIN
Authorized Official First Name:
LLOYD
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
818-574-0078

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com