Provider Demographics
NPI:1164657748
Name:LIFESOURCE TECHNOLOGIES INC.
Entity Type:Organization
Organization Name:LIFESOURCE TECHNOLOGIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONZELLA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-736-6160
Mailing Address - Street 1:1307 W 6TH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3294
Mailing Address - Country:US
Mailing Address - Phone:951-736-6160
Mailing Address - Fax:951-736-0440
Practice Address - Street 1:1307 W 6TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3294
Practice Address - Country:US
Practice Address - Phone:951-736-6160
Practice Address - Fax:951-736-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No331L00000XSuppliersBlood Bank
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment