Provider Demographics
NPI:1306001151
Name:MNANNA WORLD,INC
Entity Type:Organization
Organization Name:MNANNA WORLD,INC
Other - Org Name:COMFORT SHOE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SUN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:858-487-7800
Mailing Address - Street 1:11619 DUENDA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1110
Mailing Address - Country:US
Mailing Address - Phone:858-487-7800
Mailing Address - Fax:858-487-0092
Practice Address - Street 1:11619 DUENDA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127
Practice Address - Country:US
Practice Address - Phone:858-487-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies