Provider Demographics
NPI:1699248302
Name:OH PHUKET
Entity type:Organization
Organization Name:OH PHUKET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:QUIROZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:619-865-0445
Mailing Address - Street 1:1406 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-1627
Mailing Address - Country:US
Mailing Address - Phone:619-865-0445
Mailing Address - Fax:
Practice Address - Street 1:401 RYLAND ST STE 200A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1643
Practice Address - Country:US
Practice Address - Phone:619-865-0445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No341600000XTransportation ServicesAmbulance
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
No3416S0300XTransportation ServicesAmbulanceWater Transport