Provider Demographics
NPI:1467548321
Name:A NEW IMAGE
Entity Type:Organization
Organization Name:A NEW IMAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:LANGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-652-9055
Mailing Address - Street 1:155 N CAWSTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-5278
Mailing Address - Country:US
Mailing Address - Phone:951-652-9055
Mailing Address - Fax:951-766-6215
Practice Address - Street 1:155 N CAWSTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-5278
Practice Address - Country:US
Practice Address - Phone:951-652-9055
Practice Address - Fax:951-766-6215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA02066500001Medicare ID - Type UnspecifiedPROVIDER #