Provider Demographics
NPI:1154616233
Name:OBJECT RADIANCE, INC.
Entity type:Organization
Organization Name:OBJECT RADIANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ATMA
Authorized Official - Middle Name:K
Authorized Official - Last Name:KHALSA
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:951-698-9422
Mailing Address - Street 1:38207 CALLE CIPRES
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9348
Mailing Address - Country:US
Mailing Address - Phone:951-698-9422
Mailing Address - Fax:951-240-3405
Practice Address - Street 1:38207 CALLE CIPRES
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9348
Practice Address - Country:US
Practice Address - Phone:951-698-9422
Practice Address - Fax:951-240-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty