Provider Demographics
NPI:1760691364
Name:IMPLANTIUM, LLC
Entity Type:Organization
Organization Name:IMPLANTIUM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-931-8862
Mailing Address - Street 1:PO BOX 640747
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94164-0747
Mailing Address - Country:US
Mailing Address - Phone:415-931-8862
Mailing Address - Fax:415-673-4582
Practice Address - Street 1:1700 CALIFORNIA ST STE 340
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4589
Practice Address - Country:US
Practice Address - Phone:415-931-8862
Practice Address - Fax:415-673-4582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA199916110010332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies