Provider Demographics
NPI:1619294626
Name:MEDISPHERE INC.
Entity Type:Organization
Organization Name:MEDISPHERE INC.
Other - Org Name:FLASH MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLASHBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-922-8202
Mailing Address - Street 1:482 W ARROW HWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2941
Mailing Address - Country:US
Mailing Address - Phone:909-592-4633
Mailing Address - Fax:
Practice Address - Street 1:482 W ARROW HWY
Practice Address - Street 2:SUITE E
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2941
Practice Address - Country:US
Practice Address - Phone:909-592-4633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53388332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6452260001Medicare NSC