Individual
ELOISE CATHERINE THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C70773
Contact information
Practice address
355 E 21ST ST, SAN BERNARDINO, CA 92404-4824
(909) 882-0193
(909) 883-4834
Mailing address
355 E 21ST ST STE J, SAN BERNARDINO, CA 92404-4851
(909) 882-0193
(909) 883-4834
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
C70773
CA
Other
Enumeration date
09/03/2024
Last updated
09/03/2024
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