Provider Demographics
NPI:1548713050
Name:PROFUSION LLC
Entity type:Organization
Organization Name:PROFUSION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-537-7900
Mailing Address - Street 1:7250 ENGINEER RD STE D
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1420
Mailing Address - Country:US
Mailing Address - Phone:619-537-7900
Mailing Address - Fax:858-384-6495
Practice Address - Street 1:7250 ENGINEER RD STE D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1420
Practice Address - Country:US
Practice Address - Phone:619-537-7900
Practice Address - Fax:858-384-6495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY54335333600000X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162315OtherPK