Organization
ST JUDE HOSPITAL
Active
Other names
Expressions Appearance Center
Organization subpart
No
Provider details
NPI number
Authorized official
TOMMIE TISHLER (CONTROLLER)
(714) 446-7200
Entity
Organization
Contact information
Practice address
101 E VALENCIA MESA DR, FULLERTON, CA 92835-3809
(714) 992-3000
Mailing address
101 E VALENCIA MESA DR, FULLERTON, CA 92835-3809
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
08/23/2012
Last updated
08/23/2012
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