Provider Demographics
NPI:1154681674
Name:EMPOWERED INTIMATES, INC.
Entity Type:Organization
Organization Name:EMPOWERED INTIMATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAVSEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-782-5745
Mailing Address - Street 1:1338 W WINTON AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-1408
Mailing Address - Country:US
Mailing Address - Phone:510-782-5745
Mailing Address - Fax:510-782-5748
Practice Address - Street 1:1338 W WINTON AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-1408
Practice Address - Country:US
Practice Address - Phone:510-782-5745
Practice Address - Fax:510-782-5748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146373335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier