Provider Demographics
NPI:1114263712
Name:SYNERGETICS HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:SYNERGETICS HEALTHCARE SERVICES
Other - Org Name:SYNERGETICS HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LIAO
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:661-317-2318
Mailing Address - Street 1:39524 DUNBAR ST
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4908
Mailing Address - Country:US
Mailing Address - Phone:661-317-2318
Mailing Address - Fax:661-272-4608
Practice Address - Street 1:39524 DUNBAR ST
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4908
Practice Address - Country:US
Practice Address - Phone:661-317-2318
Practice Address - Fax:661-272-4806
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYNERGETICS HEALTHCARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization