Provider Demographics
NPI:1326476847
Name:COMPLETE LYMPHEDEMA CARE, INC.
Entity Type:Organization
Organization Name:COMPLETE LYMPHEDEMA CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALLYN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:RANKIN-MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:925-550-3532
Mailing Address - Street 1:11750 DUBLIN BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2821
Mailing Address - Country:US
Mailing Address - Phone:925-550-3532
Mailing Address - Fax:925-831-0315
Practice Address - Street 1:11750 DUBLIN BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2821
Practice Address - Country:US
Practice Address - Phone:925-550-3532
Practice Address - Fax:925-831-0315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 6553174400000X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty