Provider Demographics
NPI:1982423117
Name:NEWU HYDRATION MANAGEMENT, LLC.
Entity type:Organization
Organization Name:NEWU HYDRATION MANAGEMENT, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:NGOH-EBANDA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CNS
Authorized Official - Phone:408-461-9125
Mailing Address - Street 1:393 BLOSSOM HILL RD STE 290
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1654
Mailing Address - Country:US
Mailing Address - Phone:408-461-9125
Mailing Address - Fax:
Practice Address - Street 1:393 BLOSSOM HILL RD STE 290
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1654
Practice Address - Country:US
Practice Address - Phone:408-461-9125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy