Organization
LA VAIL
Active
Other names
NONE
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHERILL A RADTKE (OWNER)
(562) 596-1452
Entity
Organization
Contact information
Practice address
1021 PACIFIC COAST HWY, SEAL BEACH, CA 90740-6214
(562) 596-1452
(562) 493-2472
Mailing address
1021 PACIFIC COAST HWY, SEAL BEACH, CA 90740-6214
(562) 596-1452
(562) 493-2472
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
03/22/2007
Last updated
11/20/2007
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