Organization
COOLWATERS FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ESTER N MBAYA M.D (PRESIDENT)
(858) 245-8327
Entity
Organization
Contact information
Practice address
4601 LOCUST LN, STE:305, HARRISBURG, PA 17109-4444
(717) 657-3976
Mailing address
4601 LOCUST LN, STE:305, HARRISBURG, PA 17109-4444
(717) 657-3976
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
7000000313
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7000000313
—
PA
Enumeration date
08/03/2016
Last updated
08/03/2016
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