Organization
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Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIJAY KAILAS BRIHMADESAM (CEO)
(617) 681-4141
Entity
Organization
Contact information
Practice address
14839 CORTA DR STE A, VICTORVILLE, CA 92395-4066
(704) 286-9918
Mailing address
14839 CORTA DR STE A, VICTORVILLE, CA 92395-4066
(704) 286-9918
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
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Other
Enumeration date
09/19/2019
Last updated
10/18/2023
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