Organization
FRED SUFFICOOL & DAN GRIFFIN PTRS
Active
Other names
Technician Support Services Industry, TSSI Home Medical Equipment
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN J GRISWOLD (CONTROLLER / MANAGER)
(619) 644-2170
Entity
Organization
Contact information
Practice address
7200 PARKWAY DRIVE, SUITE 104, LA MESA, CA 91942-1534
(619) 644-2170
(619) 644-2174
Mailing address
7200 PARKWAY DRIVE, SUITE 104, LA MESA, CA 91942-1534
(619) 644-2170
(619) 644-2174
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PHY44577
CA
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5614145
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
PHA445770
—
CA
Enumeration date
07/18/2006
Last updated
10/06/2010
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