Provider Demographics
NPI:1144701707
Name:SOCAL RESPIRATORY CARE
Entity type:Organization
Organization Name:SOCAL RESPIRATORY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:EDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GANEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-410-1468
Mailing Address - Street 1:1509 W ALTON AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1509 W ALTON AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7219
Practice Address - Country:US
Practice Address - Phone:949-410-1468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies