Provider Demographics
NPI:1609170356
Name:PECTUS SERVICES OF SOUTHERN CALIFORNIA LLC
Entity Type:Organization
Organization Name:PECTUS SERVICES OF SOUTHERN CALIFORNIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PORCELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-732-8876
Mailing Address - Street 1:96 BELMOHR ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2202
Mailing Address - Country:US
Mailing Address - Phone:973-488-7185
Mailing Address - Fax:
Practice Address - Street 1:317 N. ELCAMINO REAL
Practice Address - Street 2:SUITE 502
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92026
Practice Address - Country:US
Practice Address - Phone:877-732-8876
Practice Address - Fax:973-488-7185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment