Provider Demographics
NPI:1043332794
Name:PATRICIA MANN
Entity Type:Organization
Organization Name:PATRICIA MANN
Other - Org Name:VALLEY RESPIRATORY & MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:951-653-1090
Mailing Address - Street 1:12065 MORRISON ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-1802
Mailing Address - Country:US
Mailing Address - Phone:951-653-1090
Mailing Address - Fax:951-653-9590
Practice Address - Street 1:14161 ELSWORTH ST
Practice Address - Street 2:SUITE C
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-9007
Practice Address - Country:US
Practice Address - Phone:951-653-1090
Practice Address - Fax:951-653-9590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100442332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01966FMedicaid
CA0910170001Medicare NSC