Individual
ODILA CONICA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
147 N 4090 E, RIGBY, ID 83442-5888
(208) 745-9497
Mailing address
147 N 4090 E, RIGBY, ID 83442-5888
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807758200
—
ID
Enumeration date
06/25/2008
Last updated
06/25/2008
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