Provider Demographics
NPI:1588915532
Name:PHYSICIAN SUPPORT SERVICE
Entity type:Organization
Organization Name:PHYSICIAN SUPPORT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEP
Authorized Official - Prefix:
Authorized Official - First Name:RAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-995-0252
Mailing Address - Street 1:8780 19TH ST # 201
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-4608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8780 19TH ST # 201
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701-4608
Practice Address - Country:US
Practice Address - Phone:619-995-0252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-30
Last Update Date:2012-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site