Organization
FAMOUS FOAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID BRADSHAW (OWNER)
(415) 491-4799
Entity
Organization
Contact information
Practice address
2397 SAN PABLO AVE, BERKELEY, CA 94702-2055
(510) 841-9001
Mailing address
50 MOUNT WHITNEY DR, SAN RAFAEL, CA 94903-1037
(415) 491-4799
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
10/03/2011
Last updated
10/03/2011
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