Organization
HEAVENLY SENT INCONTINENCE SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARISELA D. SALAS (OWNER)
(361) 442-0720
Entity
Organization
Contact information
Practice address
5959 S STAPLES ST, SUITE 104, CORPUS CHRISTI, TX 78413-3846
(361) 442-0720
Mailing address
5959 S STAPLES ST, SUITE 104, CORPUS CHRISTI, TX 78413-3846
(361) 442-0720
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0101990
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101990
DEVICE DISTRIBUTOR
TX
Enumeration date
03/17/2008
Last updated
03/17/2008
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