Organization
DIVINANT, INC.
Active
Other names
Diabetic Outlet
Organization subpart
No
Provider details
NPI number
Authorized official
AMIR MIRABDOLLAH (PRESIDENT)
(805) 801-6027
Entity
Organization
Contact information
Practice address
13450 SAN ANTONIO RD, ATASCADERO, CA 93422-6321
(805) 801-6027
Mailing address
PO BOX 70, ATASCADERO, CA 93423-0070
(805) 801-6027
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
03/23/2021
Last updated
03/23/2021
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