Provider Demographics
NPI:1265613012
Name:SHAKTI MEDICAL, INC.
Entity type:Organization
Organization Name:SHAKTI MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:SOKOLSKY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:310-372-4200
Mailing Address - Street 1:2455 190TH ST
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-5334
Mailing Address - Country:US
Mailing Address - Phone:310-372-4200
Mailing Address - Fax:310-219-0723
Practice Address - Street 1:2455 190TH ST
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-5334
Practice Address - Country:US
Practice Address - Phone:310-372-4200
Practice Address - Fax:310-219-0723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies