Organization
SOURCE ONE MEDICAL INC
Active
Other names
Source One Medical Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS KLINE (PRESIDENT/CEO)
(888) 447-9056
Entity
Organization
Contact information
Practice address
16 TECHNOLOGY DR, SUITE 165, IRVINE, CA 92618-2328
(888) 447-9056
(949) 387-6371
Mailing address
16 TECHNOLOGY DR, SUITE165, IRVINE, CA 92618-2328
(888) 447-9056
(949) 387-6371
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
103616
CA
Other
Enumeration date
06/20/2005
Last updated
05/14/2012
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