# LIFESOURCE TECHNOLOGIES INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164657748
- **Authorized official:** DONZELLA LYNNE FLETCHER (OWNER)
- **Authorized official phone:** (951) 736-6160

## Contact information

- **Practice address:** 1307 W 6TH ST, SUITE 207, CORONA, CA 92882-3294
- **Practice address phone:** (951) 736-6160
- **Practice address fax:** (951) 736-0440
- **Mailing address:** 1307 W 6TH ST, SUITE 207, CORONA, CA 92882-3294
- **Mailing address phone:** (951) 736-6160
- **Mailing address fax:** (951) 736-0440

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 331L00000X | Blood Bank | — | NULL | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |

## Other

- **Enumeration date:** 05/26/2009
- **Last updated:** 05/26/2009