Provider Demographics
NPI:1043499858
Name:HEAVEN SENT MEDICAL SERVICE INC
Entity Type:Organization
Organization Name:HEAVEN SENT MEDICAL SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOVASCULAR SONOGRAPHER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:TAIWO
Authorized Official - Last Name:AKINDELE
Authorized Official - Suffix:
Authorized Official - Credentials:ARDCS
Authorized Official - Phone:775-443-8282
Mailing Address - Street 1:2050 RUSSETT WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-2112
Mailing Address - Country:US
Mailing Address - Phone:775-443-8282
Mailing Address - Fax:
Practice Address - Street 1:2535 JENSEN AVE
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2288
Practice Address - Country:US
Practice Address - Phone:775-443-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103502261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile