Organization
SANTE' MAMA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ERICA MATTESON (OFFICE MANAGER)
(360) 253-2229
Entity
Organization
Contact information
Practice address
113 NE 92ND AVE, VANCOUVER, WA 98664-2541
(360) 253-2229
(360) 944-0606
Mailing address
113 NE 92ND AVE, VANCOUVER, WA 98664-2541
(360) 253-2229
(360) 944-0606
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2009709
—
WA
Enumeration date
09/12/2010
Last updated
01/08/2014
Update your record
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