Provider Demographics
NPI:1710509146
Name:DIVINE ELECTROLYSIS LLC
Entity Type:Organization
Organization Name:DIVINE ELECTROLYSIS LLC
Other - Org Name:DIVINE ELECTROLYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARACELI
Authorized Official - Middle Name:
Authorized Official - Last Name:GADEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-952-8279
Mailing Address - Street 1:2924 E SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7549
Mailing Address - Country:US
Mailing Address - Phone:909-952-8279
Mailing Address - Fax:
Practice Address - Street 1:1525 S GROVE AVE STE 2
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-4587
Practice Address - Country:US
Practice Address - Phone:951-215-6065
Practice Address - Fax:909-752-7205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty