Provider Demographics
NPI:1083057848
Name:DYNAMIC HEALTH SERVICES - SB
Entity Type:Organization
Organization Name:DYNAMIC HEALTH SERVICES - SB
Other - Org Name:DYNAMIC HEALTH SERVICES - SB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OMBAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-405-0449
Mailing Address - Street 1:596 N LAKE AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1222
Mailing Address - Country:US
Mailing Address - Phone:626-405-0449
Mailing Address - Fax:
Practice Address - Street 1:25051 REDLANDS BLVD STE A
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4099
Practice Address - Country:US
Practice Address - Phone:626-405-0449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DYNAMIC HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based